House Standing Committee on Health

Good morning, everyone. Welcome to this hearing. Joint hearing for the first two bills. Joint hearing of the committees on Health and House, Committee on Human Services and Homelessness. I Chair, My name is Greg Takayama. I Chair the Committee on Health and Representative Martin. Lisa Marten chairs the Committee on Human Resources, Human Services and Homelessness.

Okay, we're getting off to smooth start. We are. For the record, we are here in room 329 of the State Capitol and it is Wednesday, February 4th at 9:01am Just to get your bearings and couple housekeeping reminders for those of you who haven't been here before.

You'll notice first of all, if you've been here before, that we have no mics. The microphones are actually in the green lighted devices in the ceiling.

And so when you do testify, we do ask you to speak from the podium because even though we can all hear you for purposes of YouTube, which is the hearing is being televised on YouTube live as we speak. So it gives you a better shot of you as you speak.

And for those on Zoom, those testifiers, we ask that you keep yourselves muted and that you not have any. You not display any trademark items because as I mentioned, we'll be on YouTube. Finally, we'll ask all testifiers to adhere to a two minute time limit and we'll have a gentle ding from our Committee people as a reminder.

But we have a long agenda this morning, so we want to be sure and get through it all and be able to hear from all of you. So with that, let's begin with the first measure on our agenda, which is House Bill 1969 and it provide state funding for colorectal screenings.

So first up, we have, let's see Ryan Yamani on Zoom or you're not Ryan Yamani. Even better.

Aloha Chair, Vice Chairs, Members of the Committee, I'm Meredith Nichols speaking on behalf of Department of Human Services. And we stand on our written testimony and I'm here for any questions if you have them.

Okay. Before you leave. Yep. I'm going to do something that some other chairs do and ask that you, instead of simply standing on your testimony, give a brief sentence or two as to where you stand on for the benefit of the audience who don't have your written testimony.

That that's. Yeah, very good. So we absolutely at the Department of Human Services appreciate the value of screenings for colorectal cancer. It's really important to catch it early on. We understand that as people may lose insurance, things like screenings become really difficult. They're out of reach financially so we appreciate what the bill is trying to do.

And then we also recognize that DHS MedQuest program doesn't have anything set up to run a program like this right now. We would have to invest in a program manager, somebody who could pre screen claims and do the administrative work that would be involved in making sure a program like this could work.

But we absolutely understand and appreciate the importance of this type of screening.

Thank you very much. Let's see. We have Department of Health offering comments.

Good morning. Chair Takayama and Chair Marten and Members of the committees. I'm Lola Ervin representing Department of Health. The Department of Health offers comments and in terms of a short introduction to the issue, we know that 42% of people who are of eligible age, that's 45 to 75 years of age, have not been screened for colorectal cancer.

The Department of Health is also concerned that those age 45 to 54 years of age. So if you fall in that bracket, we are speaking to you. Only 45% of the people in Hawaii have been screened.

And so we are working on an educational campaign called I Got Screened to help people understand that it's for all of us and it can help prevent cancer. So age 50 and younger are now. Colorectal cancer is the highest leading cause of death for those age 50.

And so we offer comments and we do defer to the Department of Human Services.

Thank you. Okay, thank you very much. Insurance Commissioner Scott Seiche. I know you're not Scott sick. Thank you.

Good morning, Chair, Chair and Vice Chair, Members of the Committee. I'm Justin Chu, I'm with DCCA's insurance division. And you have our testimony providing comments, our comments around the reference to the FAQs, the frequently asked questions. So our concern is that the FAQs are sub regulatory. So they're not actually law, they're guidance provided by the Administration.

And they can change over time. Sometimes they can go forward, sometimes they can go back. So by not having a specific reference, the mandate of state law, what state law needs to cover can change over time based on the guidance of the Federal Government.

And similarly, because it's not a federal law, it could be subject to ACA deferral, which means that the cost, additional cost to individual plans on the marketplace could be borne by the standard.

Sure. So if we removed the FAQs from the language, would we be okay with just the US Preventive Services Task Force language which prescribes what?

I believe the USPSTF Task Force language is already in the statute. Okay, thank you.

One thing I learned is if you write notes when you're wearing reading glasses. It's hard to read without reading glasses. Thank you. Let's see. Hawaii Primary Care association no offering support. Cynthia A. American Cancer Society.

Chairs, Vice Chairs and joint Committee Members Cynthia Al on behalf of the American Cancer Society Cancer Action Network or ACS, can testifying in strong support for House Bill 1969, which establishes a dedicated public funding assistance program for colorectal cancer screening for uninsured and underinsured Hawai'i residents. The bill addresses a critical gap in preventive care.

Cost remains one of the most significant barriers for individuals without insurance. Without insurance coverage, people are far less likely to receive routine preventive services, including life saving colorectal cancer screening. As a result, they often forego unscreened, leading to late stage diagnoses, more complex treatment needs and poor health outcomes.

In Hawaii, over 58% have late stage diagnoses and those costs for treatment is over $100,000. Hawaii is expected to see an increase in residents losing health coverage when Medicaid work requirements begin in 2027. For these individuals, access to screening will become even more limited. Colorectal cancer is one of the most preventable and treatable cancers when detected early.

Yet it remains the second leading cause of cancer deaths in Hawaii among men and women combined. A recent ACS study published in the Journal of American Medical association found that colorectal cancer is the only major cancer with rising mortality among people under 50 increasing by about 1.1% since 2005.

In 2023, colorectal cancer became the number one cause of cancer death in this age group. An alarming shift that makes it the fastest growing cancer threat to working aged adults.

Investing in screening today will save lives and reduce long term costs to the state and ensure that those at greatest risk, the uninsured and underinsured, are not left behind. Mahalo for the opportunity to testify and support and for your commitment to the public health of our community. Thank you.

Okay, thank you, Cynthia. Let's see, we have also from the American Cancer Society, Daryl Korozawa in support Hawaii Medical Association. Good morning.

Aloha. Good morning Chairs Marten and Takayama. I'm Dr. Elizabeth Ann Ignacio. I am the Maui physician and representing Hawaiian Medical Association. Appreciate the comments in the American Cancer Society as well as looking at the age we stand in support of this measure and are available for questions.

Thank you so much doctor. Let's see, we have white colorectal cancer and support and we have testimonies and written support from let's see 1415 individuals have I missed. Anyone else who wishes to testify on House Bill 1969? Anyone on Zoom?

Okay.

Okay. Dr. Lewin.

Yeah. Chairs and Vice Chairs. I. I just ship did wrote testimony this week for about 90 bills. We didn't write one for this because we were trusting that we have many other resources here to support this. And notwithstanding the difficulty, for the record. Although we all know who you are. Oh, Jack Lewin shipped in.

And notwithstanding the difficulty of the screening process for colonoscopy, this really is an important area for us and we have a long way to go. So we do appreciate your support. Thank you.

Let's see with that. Anyone else wishing to testify, if not Members? Any questions? I do have a. Okay. I do have a question for dhs. Marilyn. And I just wanted to have you tell us how much the cost would be for this implementing this.

Sure. It could be between 1.4 to $2 million annually. This is an estimate. And then on top of that, some administrative costs.

1.6 to $2 million.

Yes. Thank you very much.

This is a follow up. You said you may need one fte.

Yes.

Okay.

I'm sorry, I'm sorry. Hi, good morning. I just have a question. How much time would it need for the Department to create these new positions that would be needed and to fill those positions?

Sure. That could take. Thank you. I appreciate that question. It could take some amount of time, hard to estimate. I would.

If we're able to move very quickly, I would say then maybe anywhere between six months, once to a year to establish a position description, receive a position or redescribe an existing position and then we'd have to create the rules.

So I think just to make sure we're managing expectations that there would be an amount of time, I would guess between six months to a year to get this fully established.

Okay. And I'm sorry, I have a follow up question to that. Would this bill need to be passed in order to create those positions or could those positions be created prior to this bill being committed to law?

These. These positions could. A position to manage this could be created. However, if we wanted the position to specifically target colorectal screening and colorectal screening only, then we would have to, you know, have a reason that we're. We'd have some have to tie to a reason that we're establishing such a position. Thank you. Thank you.

Thank you very much. No other questions. Let's move on to the next bill which is House Bill 1965 relating to requiring all health carriers to allocate no less than 6% of the carrier's total medical expenditures to primary care providers. For first up, we have Insurance Commissioner.

Good morning again Vice Chairs Member of the Committee Justin Chu for the Insurance Division. The Insurance Division has submitted a number of comments on this so I'll try to summarize them and keep them brief.

So with regards to the premium freeze, the department's concern that it conflicts with our current standard that insurance rates not be excessive, inadequate or inferior unfairly discriminatory which could create unactually sound premiums.

Second, with regards to the definition of the mlr, the medical loss ratio Medical loss ratio is a term defined by federal law and CMS calculates what that MLR insurer is also. But CMS is the entity that determines what that MLR how it's defined.

So you know a state law that tells CMS how to calculate MLR I don't think would work.

Next, the regarding the external review process for down coding claims, we note that we don't have an external review process currently in statute and so we would prefer some if the you know the Committee or the Legislature would like to move forward with this we'd prefer guidance on what that external review process would be or if we you know what whether currently we have an external review process for medical necessity and we administer that process that review goes to external an iro, an independent review organization.

And so it's unclear whether this would have us administering a similar or doing the external review ourselves. And then there are a few sections section the new section E J, Q and K that create new authorities for the commissioner. And we just note that these powers already exist within the insurance code.

Section I requires us to the insurance commission to have a public reporting format and we just prefer more clarity. As mentioned in our comments section R requires carriers to cover medically necessary inter island transportation. Sure.

We think this would be a new mandate that would require an auditor study determine the cost analysis of the coverage and then also could be could trigger ACA deferral. And then finally there are a few terms in the measure that we think could use definitions or clarify. Thank you. Thank you Justin.

You did a great job of summarizing lengthy testimony. Appreciate it. Let's see. Next up State Health Planning and Development Agency. Dr. Lewin.

Good morning. Chair Takayama, Chair Marten, Vice Chair Keohokapu-Lee Loy and Olds and honorable Members. SHPD really thinks this bill was thoughtfully crafted by the physician community and we think that every every provision here has merit but I'd like to distill it down to what's the most important piece of it, which is expanding our investment in primary care.

Of the 38 OECD nations, richest nations in the world, we are the only one that hasn't recognized this, the value of this. There are insurance entities on the mainland and companies that are investing more than 10%. The goal will be 12 to 15% of total healthcare spend. The word medical loss is kind of an unfortunate term.

It means the percent is not administrative, just the health care spend. And we know that this will result in lower health care costs, better outcomes. And it's just absurd that we're the one nation out of the 38 that hasn't recognized this. I might just mention the other 37 nations spend about 7% of their GDP on healthcare.

We spend 17%, and they all have better healthcare outcomes than we do. So when you learn this, it's going to be a little bit of a painful transition process because it probably will have a temporary premium increase as we get there. But in the long run, this will save a huge amount of money.

So I like to say that's the most important facet of this bill. We should find a way as a state to move in this direction and to just do this together. I will also mention that the Department of Human Services, Med Quest Division and SHPD are the partners in the ahead grant.

And this grant requires over eight years that we get to this goal. So this is a goal. The Federal Government has this a goal that we should have. Other states are moving in this direction. Let's, let's take action. Thank you very much.

Let's see. Hawaii Healthcare Task Force, I believe on Zoom. Dr. Scott Grosskreutz.

Good morning, Chairman. My name is Scott Grosskreutz, the President of Hawaii Healthcare Task Force, and I'm a physician on the Big Island. First, I want to thank all the Members of these committees that have introduced this bill. We're very grateful for that.

We're all well aware we've got a chronic and worsening shortage of doctors throughout the state of Hawaii. The extent of the doctor shortage on Maui and the Big Island is now over 440%. And you know, I can assure you based on both mathematics and biology, that that shortage on the neighbor islands could get much worse.

We could reach the 60 to 70% range of physician shortage on the neighbor islands. First, we have multiple primary care clinics on both Maui and Hawaii counties that are at severe financial distress just in the last month that may have to close. We've got a quarter of the state's doctors in Hawaii are already over age 65.

And on the Big Island, about a third of us, myself included, are already past retirement age.

You know, as the senior providers retire or die, that just puts so much more additional stress on our burnt out remaining primary care providers, which is going to force a lot of them out of the current market into primary direct payment models.

And that means that if you're a Medicare or Medicaid patient, particularly on the neighbor islands, you're going to be in a world of hurt. You know, at a bare minimum, primary care reimbursements have to be increased to 6% by January of 2027 just to keep these clinics going.

There's been a lot of other states, as Dr. Nguyen mentioned, like Connecticut, Delaware, Oregon, Rhode Island, Virginia have already passed similar bills that put the primary care spend to about 11 to 12%. So California and New York and other large states are also considering this.

It can't be said there may be some challenges that this can't be done because this has been done repeatedly already in the United States.

You know, I think in hindsight, everybody in Hawaii can appreciate that however expensive it would have been to have fire mitigation measures in place on Maui that could have prevented the catastrophic behind of fires that so damaged that community would have been worth it. There'll be billions of dollars spent on settlements and also on rebuilding from that.

And on a similar vein, you know, we basically have our primary care network, the private practices throughout the, you know, the rural areas and the neighbor islands, they're basically on fire. And if they go down, and many of them are. We'll be in the.

Position where costs will skyrocket because we have so many more patients going to the emergency rooms, unnecessary hospitalization, advanced cancer care. So I'm just really encouraging the Committee to hear this bill and pass it. Thank you, doctor.

I'm sorry, I skipped over the State Department of Human Services.

Aloha Chairs Vice Chairs Meredith Nichols for the Department of Human Services. The Department of Human Services supports the intent of this measure.

We did offer some comments suggesting that a broader definition of primary care investments extending beyond payments made to primary care providers to additionally consider investments in specifically beneficial primary care services and primary care supports and reductions in low value primary care services.

Continued investment in high quality primary care has been shown to reduce unnecessary hospital visits, leading to overall savings in health care spending. DHS strongly supports increased investment in primary care and encourages such investment through its Quest Integration contracts. Here's the good news.

In calendar year 2024, the five managed care organizations in the Quest Integration Program invested at least 9% of their total medical expenditures on primary care, with 7% of the payments supporting primary care visits, 1% supporting quality bonus payments, and 1% supporting beneficial primary care services such as screenings, immunizations and other preventative health care interventions.

The Quest Integration Program spent an additional 3% on primary care supports defined as supportive services needed to prevent readmissions and poor health outcomes such as care management, mental health and substance use treatment, and supportive housing, and identified 1% of payments in low value primary care services.

So in 2025, with legislative support, the Med Quest Division increased its investments in primary care by increasing the Medicaid fee schedule to 100% of Medicare. And DHS also remains strongly supportive of continuing to increase beneficial primary care spending by leveraging, as you heard from Dr. Lewin, the ahead grant working close partnership.

Thank you very much. Let's see. We are from written support from Hawaii County Council Member Jen Kagiwata. Next, let's see Hawaii Healthcare Task Force. David East. Oh, I'm still.

Chair Members of the community. Thank you for hearing this. My name is David Issey. I'm the Executive Director of Hawaii Healthcare Task Force. I'm going to keep this short because there's a saying that says necessity is a mother of all invention. We are, we are past that place right now.

We are in a place of survival, most especially on the big island of Maui. And then so to keep this really concise, I would say at the center of this bill is the medical loss ratio. So let's look at that MLR.

While the MLR is meant to show how much premium dollars are spent on healthcare, in practice it often reflects how spending is classified, not whether patients can actually access primary care. Plans can appear compliant on paper while primary care declines and clinics remain unfunded and unable to stay open.

So there are so many ways we can look at this. There's support for it. There are comments on it. Hey, maybe we can make amendments on that. But we are not in denial of what the plan problem is. So if at all, let's look at the MLR part of it and actually do what is right for Hawaii.

Thank you.

Thank you very much. AARP Hawaii.

Good morning. Chair Takayama, Chair Martin, Members of the Committee, I'm Audrey Suga Nakagawa Director for AARP Hawaii and we stand in strong support of this bill. You know, you're going to hear, you're hearing all the technical complexity and the administrative complexity of this bill and definitely they're all very well appreciated and understood.

What I want to share with you is the consumer's perspective of the importance of having primary care, the number of our physicians retained in our Hawaii and recruiting more and more as our aging population grows. How many of you have tried to get a doctor's appointment when you're sick?

It's becoming really hard to get a San Diego appointment with your primary doctor because they're overloaded with all the other patients that they have now had to absorb because of the growing increase, the shortages of the primary care physician.

We know the importance of the primary doctor, especially as one person ages because of the complexity of the healthcare problems that tend to arise when the person ages. Just to give you an example, when my father was working throughout his adult life, he was very healthy. He had only one doctor.

He turned 67 and all of a sudden he inherited five doctors because all these health problems started to surface.

And if it wasn't for his primary care doctor who was the captain of the healthcare team, he was able to have really ultimate care with good coordination, good communication, streamlining all his medication and he lived on for another 20 years.

This is a very example, an example of how important the primary care doctor plays, especially in our health care system.

And definitely the problem of them leaving health Hawaii, retiring early and not being able to recruit new younger doctors to take place in the healthcare system is going to become even more of a pressing problem as our population ages.

And I just want to also point out that this is not an issue just for the older adults, but it is also for our young people as our children and grandchildren ages out from their pediatrician, they need a primary care doctor too. So thank you very much.

We really appreciate this effort to strengthen and increase our workforce of among physicians. Thank you.

Thank you. Hawaii Medical Association.

Doctor Elizabeth Ignacio Maui Physician Hawaii Medical Association we support this measure. I think this is a great measure.

We did add some amendments that we offered in our testimony, just to clarify the definition of the community access primary care site that reassures that it's a qualified licensed health care provider with appropriate referral capabilities when necessary and reasonable patient support, navigation services for preventative care and major comprehensive continuity of care.

This is really important so that we're supporting our investments that are supporting long term care of our patients. But thank you for this hearing, this measure and we support it. Available for questions. Thank you.

On Zoom, I believe we have Mohammad Health Dr. Esther Smith.

Hello. Thank you. Chair Takayama and the Vice Chair Lee Loy. I don't need to extol the virtues of primary care for all are in agreement that the intent of this bill is solid. So what we are left to discuss is is it possible or practical?

Well, that MLR we keep talking about which allows insurance companies to keep 15 to 20% for Administration and the rest have to go to medical care is proof of the concept that we can regulate the percentages of how these dollars are spent. And let's acknowledge that most of it is our tax dollars.

The second thing is is it possible? And it's possible without increasing premiums.

And the example I just want to give is that during the pandemic's shutdown when there were almost no doctor's visits and there were no elective procedures done, the insurance companies saw the greatest revenues they ever saw and they were able to maintain that exact ratio, 15 or 20% despite the decreases in services.

That's the kind of control they have. And immediately after or during the shutdown, almost. In Hawaii, one of our largest insurers moved 230 jobs from Hawaii despite having had record income. There are ways to maintain premiums at their current levels and increase the primary care spend. These.

They are numerous and the argument should not be made that it's impossible. In the last few seconds I wanted to talk about this bracelet which was given to me by a patient's daughter because her mother broke her neck and was stuck in the hospital. This is only a few more seconds.

And had come out of the hospital and was homebound and they could not get her in and out of that building again. But insurance companies require an in person visit in order to get home health services. She did not have a primary care provider because her primary care provider had died.

And so I went there and I saw her and she became my patient. They need more of us and the only way there's going to be more of us or even keep the ones we have is we with more support. Thank you.

Thank you, Dr. Smith. HMSA.

You know, we support the intent of this bill. You know, continue to invest in primary care, allowing for access and they are the lifeblood first line for all of our members and for HMSA. We exist because of our members, but it doesn't happen in a vacuum.

There's the hospitals, the providers, all of this health care system is what allows our members to get the adequate and highest level of care that we as an organization strive to provide for for them as well as residents across the state.

We do have some concerns in some of the mechanisms as to how to get to the 6% and the eventual tier 12% in 2029 without increasing premiums. We don't necessarily know where that increase of spend potentially would come from, which is typically borne by our employees as well as other payers into the system.

As well as removing or limitations of risk and quality control metrics. Previous testifiers have brought up other states that have mandated percentages of medical spend tied to primary care.

Five that we found Virginia, Connecticut, California, Oklahoma and Rhode Island all continue to utilize quality metrics and their, I guess, calculations of coming up with this as well as coming through a workforce, excuse me, Task force are working with various stakeholders including, including physicians, payers as well as consumer protection protection advocates.

So at this time we appreciate you accepting our testimony. Happy to answer any questions. Thank you.

On Zoom Waianae Coast Comprehensive Health Center Ian Ross.

Aloha, Chairs and Vice Chairs Ian Ross with Waianae Comp.

We put comments for board and we want to say that we do support the intent in addition to our written testimony. We do want to concur with Ohara, Hawaii of which we are a Member.

Their testimony outlines our concerns in more detail, offers areas for potential amendments for this measure or areas for consideration for your committees this session and beyond. Thank you very much for this opportunity to testify.

Thank you. See, that's all the testimony I have in person or on Zoom. And we have in addition about two dozen other testifiers either offering support or comments. Have I missed anyone else wishing to testify in House Bill 1965? Seeing none. Members questions.

I have a question for the task force, please, if you wouldn't mind. Coming up. So just to understand better, when we talk about what they've done in other states or what your vision is, when you talk about increasing the percentage, is it just as simple as increasing the payment for primary care services?

Is it doing more what Medicaid was talking about, ancillary services like case management or what would that extra money go to? What would it look like?

So ma', am, the way it is right now those funds are not allocated for what they're supposed to be doing. So it's a shortage of the funds we're not receiving. So everything that covers primary care, it covers them. It also goes into alleviating administrative burdens and that's which is putting them in a bottleneck where they can't.

They have to shuttle if they want to do administrative services or they want to do medical services. So it dovetails into hiring and dovetails into prioritization, spending time in prioritization, not able to hire staff. So those other states have done that, have been able to increase those percentages where you actually enable people to stay in the job.

So that's basically what it calls them to.

So I'm not sure if I understood you. So more, more of the payment that is coming already for primary care would get allocated differently. Correct. More towards direct service, less towards Administration. Correct. Okay, but you're not thinking that we need rate increases like Medicaid did rate increases to match Medicaid. Sorry? Medicaid did rate increases to match Medicare.

You're not suggesting that our private health insurance organizations need to increase their rates for primary care services?

We're not suggesting that.

Okay. All right. Thank you. Thank you, Chair. Thank you.

Thank you, Chair. I have a question for HMSA please. I'm curious. We've heard a lot of the impending merger with One Hawaii Health. Will your impending merger lead to an increase in access to primary care for your members?

You know, Representative Amato. Thank you for the question at this time. I don't think I would be equipped to answer that specifically. I'd be happy to get you one from if you'd like after.

I would appreciate that. Thank you. Thank you, Chair.

Any other questions, ma'? Am?

Not for h. Missa for. Thank you. Insurance. Insurance Commission. Thanks. I was really curious, curious on your section of your testimony. Section 431 mandates no health care carrier shall raise premiums to meet increased primary care expenditures. Which that directive is at odds with the internal, like our insurance code. Can you expand a little bit on that?

Sure, sure. The insurance code says that rates shall be set so they're not excessive, too much inadequate, too little or unfairly discriminatory. Right. So I mean we've heard a lot of testimony about whether or not allocating more to primary care would increase or decrease costs.

My understanding, and I believe what Dr. Lewin alluded to as well is that, you know, it's a spend up front, save later system. Right. So we invest more in primary care now and Healthcare costs are saved overall based on lack of services down the road. Right. But insurance rates are sent year to year.

So we might see an increase now. It might cost more now. So if this bill caps the ability to do that, then we might see inadequate rates. That's our concern. And it could be that we see some savings now as well. It's just that there's a handcuff. Right.

In the worst case scenario, maybe they do need to go up and then. But the bill would hamper the ability for the insurance division to be able to determine that.

Okay, and then you mentioned the guidance regarding to the regulations. It was unclear about whether that internal review becomes the external review. Can you also expand that size is for 431D.

Yes. Okay, sure. Yeah. Let me see what the bill states.

Okay.

So okay, this is regarding down coding and it says that each subsection D on page eight it says each down coded claim shall be subject to expedited external review and final determination shall be issued within 15 days. So I brought up an analogy earlier to medical necessity.

So you know there's an insurer review about whether or not a procedure is medically necessary. And if the insurer determines that it's not, then they can ask someone else, independent third party to do so.

I assume that this asks for the same thing, that if the insurer has a dispute about down coding and the insurer says it's correct because the first right of review goes to the insurer, then the physician or healthcare provider can ask for independent party to do that.

And so our concern is that we have a statute, 432E Part 4. It sets up a process for this external review. And here it just says to do an external review, which we don't have a process.

Okay, thank you. Thank you for that clarification.

Okay, thank you Members. No other questions. Let's move on. House Bill 1804 establishes a legislative long term care Financing Advisory Commission to examine the feasibility of options for long term care services and supports.

First up, we have Legislative Reference Bureau.

Offering comments from the Department of Human Services.

Vice Chairs, Members of the Committee, Meredith Nichols on behalf of Department of Human Services. And we're standing in support of the establishment of this long term Care Financing Advisory Commission so that we can really dig in and examine the feasibility of different financing options for long term care services and supports.

And then of course we also support the bill's requirement that the Director of DHS and the administrator of the DHS Med Quest division or their designees serve as ex officio Members of this commission.

Thank you. I, I should note for the record, even though LRB Legislative Reference Bureau is not here, that in their written testimony they express concerns about the measure even though they don't take a position.

And they said that LRB notes that it does not have any specific expertise in long term care services, financing and insurance actuarial assessment or fiscal analysis. They do other things. So let's move on to Department of Health in support. I'm sorry, Department of Health, Office on Aging.

Caroline Cadirao, Director, Executive Office on Aging will stand in strong support of this measure. Thank you.

Okay.

Dr. Jack Lewin, good morning again. Chairs, Vice Chairs and Members. This, this bill actually originated in the Kupuna Advisory Council for the State Health Planning and Development Agency. The council looked toward the problems we're facing in terms of the expanding cost of long term care and the unavailability of services to people of lower income in many instances.

And this is a planning process and one that we really should undertake as a state. Back in 1990, our Executive office on aging did put forward a large plan to finance this kind of work.

Because if you're going to finance long term care, we have to start contributing to the financing when we're young, not when we're five years from retirement. So it's a matter of small amount of investment all through life can produce the resources needed.

So we have, you know, we have, for people that are eligible for MedQuest, we have much more availability of services. But so most of our kupuna are not. And these are the people that are suffering when they really need care in the long term area and their families. So this is a really great planning process.

Thank you. AARP.

We should undertake it. Thank you very much.

Good morning. Audrey Suga Nakagawa from AARP and AARP stands in strong support of this measure. God, I feel like I'm really aging because I do remember when the 1990s, the family hope program was going on and I do remember in 2011 there was a commission that actually tried to tackle this issue. So this is long overdue.

Really appreciate the effort and I'm getting close to where I might need long term care soon. So please, I really hope we can. Thank you very much.

Okay, let's see. Healthcare association of Hawaii on Zoom.

Good morning, Chair. Hi, good morning. We'll stand in support of this measure with the Healthcare Association of Hawaii Hawaii. Our only request is to potentially add other types of providers of long term care, including skilled nursing facilities, assisted living facilities and home health agencies as part of the Commission to provide that that perspective to any report.

Thank you.

Okay, thank you. Let's see. We have testimony from about eight other organizations and individuals and all of them in support. Have I missed. Anyone who wishes, please step forward.

Hello, Members. My name is Melissa Pavlicek. I'm here on behalf of Age Pacific West and we submitted some support testimony, but it was quite late and I just wanted to note it for the record. Thank you.

Okay, thank you very much. Let's see again, anyone I miss, if not Members. Questions? No questions. Okay, let's move on. House Bill 1976. Requires the provision of at least one hour of dementia specific training for first responders. And first up we have Executive Office on Aging.

Good morning, Chair Takayama, Chair Martin, Members of the joint Committee. I'm Caroline Cadirao, Director of the Executive Office on Aging. And we support the intent of House Bill 1976 related to dementia.

As you said, it requires one hour of dementia training for our first responders and it requires Executive Office on Aging to review and recommend and training for first responders. We have three recommendations that we'd like to share. The first is making an amendment to adjusting the training start date right now in the Bill.

I think, I believe it says January 1, 2027. We're asking due to our strange workforce capacity if we could move that by six months to July 1st of 2027. And that also allows as the enforcement standard board to have time to review the trainings that are being recommended.

Also to align with the change in the start date, we need to the cycle completion date change to June 30th of 2028 and then under our HRS349 for the Executive office on Aging. We ask that we strike out lines 15 through 22, low cost, no cost specific training curriculum for nonprofits.

And we'd like to replace it with the Executive Office on Aging. She'll seek low to no cost dementia specific training curricula. Executive Office on Aging shall identify whether the training has an associated fee or no cost in the development of the curriculum list that we're going to put together. Thank you so much for this opportunity to testify.

Another question.

Questions? Thank you. Thank you. Hawaii Emergency Management Association HYEMA offering comments. AARP.

AARP stands on our testimony and support.

Alzheimer's Association Hawaii.

Hello Chair Takayama, Members of the Committee, thank you for scheduling this bill. This is so important as you all are very. I think we met with each and every one of you at some point and you all understand this issue. We have about 31,200 people living with Alzheimer's in the state.

We're expecting this number to double in the next 25 years. It is not uncommon for someone living with dementia to wander at some point in their life. About 60% of people is what we estimate. And in terms of wandering, you have people who go out and about and they don't have the same reality that we all do.

They're experiencing something that's a little different, especially in the middle to later stages of the disease. And we want to make sure that our law enforcement agencies are well suited to handle these situations so it doesn't escalate to anything more than it needs to be.

On the other hand, you have a lot of readmittance of people living with Alzheimer's into the ER. We have about 1,248 people who going to the hospital or ER for every 1,000 people living with Alzheimer's.

So we're always seeing people go back to the ER, and more often than not, when it's a very dire case, EMS is going to respond and they need to be able to manage the situation properly. And then finally, you all know that our state has been seeing an increased number of wildfires and other natural disasters.

So when fire responds, we need to make sure that they're able to communicate effectively with the people living with Alzheimer's, because again, they don't live necessarily in the same reality that we all do.

So if you have someone who is experiencing smoke in the house, a lot of heat, you can imagine it's already kind of a chaotic situation. And then you have this smoke man or woman who's kicking down the door, you don't understand what's happening, but you're in the sense of and state of panic.

It's important that we're able to kind of manage this situation to keep all of our kupuna and loved ones impacted and living with Alzheimer's disease safe in these situations. So we thank you again for hearing this Bill and we ask for your support in passing it through. Thank you.

Thank you very much. On Zoom, I believe we have Barbara Black. Black.

Good morning, Chairs and Members. My name is Barbara Black and I live in Ninoli in the Big Island. And I am a caretaker for my husband Peter, who has Alzheimer's. I strongly support this to ensure the safety of those living with Alzheimer's.

It breaks my heart to think of Peter wandering somewhere, confused and possibly frightened, being treated harshly and without compassion. I remember a neighbor out walking and clearly unaware of who we were, but who took our hands with a smile as we walked her to her home.

And while most people are kind and caring when they see an uncertain and possibly lost person, and I'm always grateful to be living on this wonderful island, that may not always be the case.

And one hour of training each year for first responders, which is already provided by the Alzheimer's association, covers communication techniques, de escalation strategies, recognizing the signs of dementia, and how to safely help someone.

I respectfully urge you to support this bill so that Hawaii's first responders have the tools they need to interact safely and effectively with people living with dementia and so people like me can feel more confident that their loved ones will be treated with understanding and care during an emergency. Thank you for the opportunity to testify.

Thank you. Now, also on Zoom, I believe we have Peter Black.

Yes, you do.

Oh. Go ahead. I'm sorry about that. So, yeah, I have Alzheimer's. There's no fun. I'll just read you a little thing I wrote. I have no clear idea of what my future will be, but if I live long enough for my dementia to render me incompetent, be on my own.

I really hope any encounter I might have with a first responder, be it a policeman or a fireman woman, is it an encounter with someone who was ready to deal with me appropriately. Thank you very much for the opportunity to testify.

Thank you very much, Mr. Black. Best of luck to you.

Thank you.

That's all the testifiers I believe we have on Zoom or in person. We have about eight to 10 others organizations and persons and expressing support for this measure. Anyone I missed who wishes to testify on this, if not Members. Any questions? Seeing none.

Before we move on, I just need to add a personal anecdote from Alzheimer's association knows about.

My dad suffered from Alzheimer's and years ago he actually wandered off in the middle of the night and a kaneohe policeman found him sitting on a playground swing eating a box of Chinese takeout food, which to this day we have no idea how he acquired because he didn't have a wallet with him.

And a policeman told him that, contacted your family, someone will come by to pick you up. And we did. But I just wanted to point out how important it is to interact with those who suffer from Alzheimer's or dementia on a very compassionate basis, which in this case, we were fortunate, so fortunate to have experience.

But I think this is important. Next, Bill HB 1530 relates to residential community treatment and requiring contracts to include certain provisions regarding residential treatment programs. And first up, we have Blade State Department of Health.

Good morning Chairs, Vice Chairs, Committee Members. My name is Kaylee Okuaro. I'm the Administrator for the Child and Adolescent Mental Health Division and I'm here representing the Department of Health. Today we did provide testimony offering comments on this measure. While we appreciate the intent of the measure, we would want to just flag a couple of concerns.

One being that the additional requirements are potentially stigmatizing for the youth who live in these homes and the adults who live with and care for these youth. And also that the proposed increased requirements could add additional challenges to providing community based mental health residential care for youth in need of this level of support.

We would respectfully suggest that the current requirements for programs of this type are adequate to address the needs of youth communities in the state and that we already have the authority to adjust any contractual requirements if that was deemed necessary. So we don't believe that legislation is required to do that. Available for any questions.

Thank you for the opportunity. Opportunity Customer thank you very much.

Department of the Attorney General.

Good morning Chair Takayama and Members of the Committee. I'm Michelle Nakata, Deputy Attorney General. The Department of the Attorney General provides the following legal concerns and comments. The Federal Fair Housing Amendments act and the Americans with Disabilities act prohibit governmental entities from discriminating against persons with disabilities in housing.

This bill would require any person applying to contract with the Department or to renew or extend a contract for a youth mental health residential treatment program to obtain and maintain general liability insurance policy with certain minimum coverage amounts, submit for review and approval a community safety action plan to the Department and to provide the community plan to a community association and or a neighborhood board.

It also requires the programs to provide written notice of the program's establishment and location to the community association or the neighborhood board. These requirements are not required for any other family homes. They only apply to small group homes for youth with mental health disabilities.

Courts have found that written neighbor notice requirements and safety requirements that only apply to group homes for persons with disabilities by violate the federal Fair Housing Act. Since this bill also requires the Department of Health to provide administrative rules to implement this section, these requirements may also be subject to challenge under the Fair Housing Act.

Our points are covered in more detail in my testimony. Thank you for the opportunity to provide comments.

Thank you very much. Catholic Charities of Hawaii Comments or actually Testimony and opposition Thomas Lau on Zoom.

Hi, I'm sorry. Can you hear me?

Yes, we can hear you. Please proceed.

Hi, I am a Newtown resident. The treatment facility should not be in a residential neighborhood. The IAEA neighborhood board overwhelmingly voted against the special treatment facility in Newtown. Catholic charity used a loophole to bypass public hearing to put the treatment facility in a residential zone.

I don't know why the state put a treatment facility for adjudicated sexual deviant teens in a residential neighborhood. Bringing teens that must meet all the dangerous criteria Department of Health require for admission. This criteria ensure that only dangerous teens can be housed in a facility in a residential neighborhood.

For the Department of Health, there are many needs for this type of facility. But because of Catcher charity use the loophole to bypass public hearing. The facility is only limited to house five kids. Catholic Charities application budgeted $5.5 million for the treatment facility for three years at a very high cost of 342,000 per teen per year.

If Department of Health increases the maximum treatment facility capacity, more teens can be treated at lower cost per teenage, but they need to open it up for public hearing. In summary, a treatment facility at this high level should not be in any residential neighborhood.

Department of Health did not consider community safety and security in their certificate of need evaluation criteria. More than a year after the contract was awarded to Catholic charity, they still don't have a safety action plan for the community. A safety action plan is a contractual requirement on Department of Health's contract. But they continually overlooking it.

There are many risks to us. Please, please help us protect our family. I support this bill. Thank you. Thank you.

Naomi Yap.

Good morning, Representative Takayama and Chairs Members of the Committee. My name is Naomi Yap and I'm here in strong support of HB 1530 relating to youth mental health residential treatment programs. Specifically the provisions on community notification.

HB 1530 requires that any person applying to contract with the Department or to extend or renew a contract to operate a youth mental health residential treatment program must provide the following to the applicable community association or neighborhood board for the area in which the board program will operate.

Number one, Written notice of the program's establishment and location and two, the program's community safety program plan. These notifications are required as a condition for the Department to enter into, extend or renew a contract, especially for sexually reactive use. This Bill is important for several reasons. Number one, Transparency builds trust between agency provider and neighborhood.

When a youth mental health residential treatment program is licensed and operating without informing nearby residents, it undermines good faith community relations. Two, early communication prevents escalation and conflict and three community input is critical to the review and approval process.

In conclusion, community notification is essential because it protects residents welfare, upholds transparency, promotes collaboration and ensures meaningful public participation in indecisions that affect neighborhoods. For these reasons, I respectfully urge you to pass HB 1530. Thank you.

Thank you very much. Jeannie Oy.

Good morning. Chair. Vice Chair. Members of the House Committee on Health. My name is Jean Omaye and I am testifying in strong support of House Bill 1530. This bill does not address the Fair Housing act or the need for such a facility. The facility is already there.

It addresses safety issues related to a facility that houses sexually reactive use in a residential community. Following a collaborative effort involving the IA Neighborhood Board, the Office of Information Practices and the State Ombudsman, our community received a community safety plan for the special treatment facility which houses sexually reactive youths in our community.

While we acknowledge the lease of the document upon review, we find that the plan fails to satisfy the child and adolescent mental health performance standards. Specifically, it lacks the policies, procedures and mechanisms required to effectively manage the risk posed by sexually reactive youth to the surrounding residents.

These include a 24/7 emergency contact number, specific protocols for when a youth elopes or leaves or when 911 should be notified. The contracted service provider argues that these facilities help youths assimilate into the community. However, true assimilation requires an effort to be of good needs.

Neighbor that starts with a plan that details the measures taken to protect both the residents and youths in their care. Currently, this facility which houses sexually reactive use is in my backyard. I ask you what happens when a facility like this is placed in yours?

Will there be a safety plan in place to protect you and the people you represent? Government agencies and large private corporations have the resources to to protect their interests. We don't. We are simply ordinary people living in neighborhoods across Hawaii.

We turn to you to stand by us in our effort to keep our homes safe, protected and untroubled. As our representatives, we ask you to join us in supporting essential safeguards in House Bill 1536. Thank you very much.

Claire Yim.

Hi. Chair Takayama, Vice Chair and Members of the Committee. My name is Claire Yim. I strongly support HB 1530 with an amendment. I respectfully request that your Committee amend this measure to only include community based residential to sexually reactive youth programs operating in a residential community in the definition of a youth mental health residential treatment program.

At the end of July 2025, a community based residential to sexually reactive youth program began operations. This program is a 247 special treatment facility serving 5 males ages 12 to 17 who have a history of challenges relating to sexual offending, aggression or deviance that prevent them from participating in family and or community life.

This is the only, I repeat, this is the only facility in the entire state of Hawaii operating this program in a residential neighborhood and operates as Hawaii's second highest level of care for adolescents just below hospitalization. The organization said that they did not complete any community outreach because they were not required to do by law.

Already three police reports have been filed for two violent incidents. So while I respect the organization operating the special treatment facility community to protect the safety of the community notification and are important especially in a residential area where children, adolescents and elderly are living.

HB 1530 will require youth mental health residential treatment programs to address safety concerns provide notice to the community. I strongly support HB 1530 with an amendment that the definition of a youth mental health residential treatment program to only include community based residential to sexually reactive youth programs operating in a residential community.

Thank you for considering my testimony in. Support with the thank you very much Randy.

You.

Good morning Chair Takayama and Members of the Committee. My name is Randy Yim. I strongly support HB 1530 with an amendment. I respectfully request the that the Committee amend definition of a youth mental health residential treatment program to only include community based residential two sexually reactive youth programs operating in the residential community.

This Community Based Residential 2 Sexually Active Youth Program is a 247 facility serving 5 bills ages 12 to 17. We have a history of challenges related to sexual offending, aggression or deviant behavior. The special treatment facility is the only facility in the state of Hawaii.

By operating in this program in a residential neighborhood and operates as Hawaii's second highest level of care of adolescents just below the hospitalization. The facility is unsecured. The youth can leave any time. If a youth elopes, the program's community safety plan is to call 911.

Since starting operation in July 20253 police reports have been filed for two for two violent incidents. I've included that in my testimony. The Pearl Ridge Elementary School bus passes this facility twice daily on the weekdays. The safety of the students must be a priority.

Again, I strongly support HB 1530 with an amendment that the definition of a youth mental health residential treatment program to only include community based residential to sexually reactive youth programs operating in a residential community. Thank you for considering my testimony and support with EDA Min.

Thank you very much. Let's see. I have written Testimony from about 20 other individuals, all of Them in support. Anyone else I missed? Anyone I missed who wishes to Testify on House Bill 1530, please step forward in person or in Zoom. Seeing none. Doctor.

I. I feel the obligation to testify on this. I didn't. I didn't actually see what the issue was, but I'd like to acknowledge that a certificate of need was issued for this facility and it was extremely controversial. In the certificate of need law, we are not. Part of.

Our statutory authority does not include selecting a location for a facility. So we had no jurisdiction in the sense of that there was a public notice. But I do think the community has a real issue of concern. This particular facility was actually in another affluent community in Nuano where they lost the lease for their property.

They existed there for quite a few years and without incident in that particular site. So the Catholic Charities and the Department of Health really thought this was safe. They tried to build some issues around it. But I do think the community deserved to have early notice so that they could consider this together.

And I think that is a legitimate kind of consideration for future. We didn't have that. You know, we didn't really have the authority to do that then, but. And while this is not had, no incident has occurred since then. And I think that DoH and Catholic Charities are doing their very best.

I will just say that the kids in this facility are abused kids. They. They've. They've been damaged. They need a facility somewhere. But unfortunately, this community didn't get a chance to really consider that in advance. So I think there's a merit. There's a merit to their concern. Thank you. Thank you very much.

Members, any questions?

Dr. Lewin. I could follow up. You mentioned the issuance of the permit, right? Is it obtained without a selected site?

The site isn't a determination that the certificate of need considers. We have six different considerations, but that's not one of them. So. But there is, you know, there's some legitimacy to community wanting to have notice before something enters their space. That's true, I think, of substance abuse facility treatment facilities as well.

So, you know, these are things we should. Should be thinking about in terms of where they're placed. Thank you.

Dr. Lewin, if I could follow up on that. Is that something internally where you guys would be able to tie the certificate to a place?

No, this is really. It gets down to. Actually, it's a zoning ordinance issue.

Got it.

That is really. Where the. That this should be a zoning ordinance.

Thank you. Any other questions? If not, I have a question for Department of Health, please.

You heard residents as well as Dr. Lewin make reference to the fact that there really didn't seem to have been any kind of community notification in advance. And I'm sorry that Catholic Charities is not here to speak for themselves. But can you talk about why perhaps there was no notification, no effort to.

Alert the community as to the nature of this facility?

I can't speak on behalf of Catholic Charities. I do know that from the neighborhood Board Meetings that we've attended together, they have expressed remorse at not reaching out to the neighbors earlier on in the process.

But I would just offer that no rules have been broken in the process of them being licensed as a special treatment facility or in the certificate of need process. It didn't violate any loopholes or anything like that. They have followed all the rules required as part of that process.

And I've been attending the started attending the neighborhood Board Meetings as a way to try to identify address questions and concerns that have come up about both the process and the program.

Can you tell us how many teenagers are being treated there?

It's licensed for five. So at any given time the census is dynamic, is admitted or discharged, but they're licensed for five?

Up to five.

Yes. I had heard that there were actually two resident. Would that be about right right now?

At different points? Yes, there have. I don't know what the number is today, but at different points there have been.

How long are they typically residing there?

A length of stay for a program of this type is typically six to nine months. That's the course of treatment.

And are there any other treatment facilities like this contracted through the Department of Health?

Right now we have other community based residential facilities that are licensed as special treatment facilities, some that are not in residential neighborhoods and another one that is in a residential neighborhood.

And in the event you are to. Issue a new contract for a new. Residential treatment facility, is it possible, can you give us the assurance that you would make an extra effort to make sure that whatever community it could be, any of ours is notified in advance as to the nature of the facility?

I think the. I mean, absolutely. In terms of that early communication being so important, I think what is challenging is that when we are putting out the competitive procurement process, we don't always know who's going to get the award and where they are planning to locate the program.

They don't have to have located the program at the time of the contract award. And so, you know, there could be a sequencing problem with being able to do that. But we absolutely agree that early communication is best. Thank You.

So it seems to me that early communication is wanted by the community to oppose having that there. I don't think that just because they knew about it before would make them feel any differently about the facility. Right. The only real goal of that early. Information is to try to block the project is there.

I know that when it comes to facilities with a mental health focus in residential areas, there's often conflicts with the neighbors. And, you know, for many of us. That let our kids run free in. The neighborhood when they were little, you could understand that a facility like that.

Would change the way you parent and the way your kids grow up. And so it really does have an impact. I wonder, is there a reason that a facility like that needs to be in a neighborhood? Like, are there treatment benefits, like kind of a normal situation? Is that important for the kids in.

The program, or could they be in. A different kind of area, like A. More commercial area or something like that?

It's a really good question. And there are absolutely substantiated benefits to youth with trauma backgrounds living in as normalized a setting as possible.

So in a home, in a community that really has a lot of benefit for young people who are trying to overcome trauma histories and who are trying to learn how to function in normal homes and in supportive communities.

And so, as opposed to being in a more institutional setting, these types of programs have been shown to be really impactful and effective in treating the types of behaviors that these youth have.

So, yes, and since we're talking about evidence and data, I would also argue that there's no data to suggest that these young people pose a safety risk to their community. And so the additional requirements feel predicated on the assumption that they pose a safety risk to the community. But there is not data to suggest that they do.

Thank you. Thank you.

No other.

I have a question, and I'm not sure if this is for Department of Health or the Attorney General's office. So my question is, you know, trying to balance the safety needs of the community as well as the treatment needs of a child.

If what is being proposed was in the administrative roles, would that address the concern that we're discussing today? So that a law wouldn't be required, or would including this in the administrative rules still be insufficient to meet the safety concerns for the community as well as the treatment needs of a child?

This bill did require the Department of Health to adopt administrative rules, and if they adopted all the same requirements, our testimony is that it may be subject to challenge under the Fair Housing act because it would be the State adopting these administrative rules and states cannot discriminate against criminal persons with disabilities in housing.

Okay, thank you. So this doesn't sound like an easy solution. It sounds like something that zoning needs to be involved with as well. That's what I gathered from today's testimony. This is the AG's office think along the similar lines. All right, thank you. Thank you so much.

That was a nod. Yes.

For the record.

Okay. Any other questions? If not Members, let's move on to the next bill. Thank you very much. Which is. And you know, I just want to thank the residents from a. Who traveled from. I'm sorry, we. You. You cannot. But I just wanted to express my appreciation for traveling from AIEA to take part in our discussions today.

We appreciate very much so your coming here and expressing your next bill is House Bill 1541 proposing to exempt certain physicians at the Hawaii State Hospital from civil service. First up, Hawaii State Department of Health.

Good morning, Chair Members of the Committee, I'm Courtney Lawson, Department of Health, Behavioral Health Administration. We support this measure which exempts certain key critical leadership and operational positions from civil service in both the different division for Disabilities and Hawaii State Hospital. I have our administrators here from those. Two sections to answer if there are any other questions.

Thank you very much. Let's see. We have just written testimony from HGEA Randy Pereira in opposition. Anyone else wishing to testify on House Bill 15 Forest 55, please proceed.

Good morning Members Nui Sebast for HGEA. We submitted written testimony opposition. We just wanted to just explain our concerns that by accepting positions, these employees won't be covered under just cost protections. We understand.

Well, we'll know that there are other ways to help with recruitment of these positions, such as adequately pricing those positions to be competitive with other public sector jurisdictions or the private sector. Thank you.

Anyone else wishing to testify on House Bill 1541 seeing non Members. Questions. Seeing none.

Oh, I'm sorry.

Sorry.

Thank you. A quick question for DOH. Thank you. You know, I understand the need to exempt positions. I know that it makes hiring a lot quicker and it makes the ability to be more competitive when trying to fill those positions. So my question is these positions that the Department wants to exempt, are they existing positions?

And if they are, how long have they been in recruitment?

So I'll have Mark Lynn Scott.

Good morning. Mark Lynn Scott, hospital administrator for HSH in that question these positions. So Act Bill or Act 230 and House Bill 1800 in the year 2024 approved appropriations for many of these positions for us. So it's been at least two years. We're in a reorganization that I've been told, so this is prior to my Administration.

I'm trying to use those dollars. So right now, to the point of labor, we're using contract workers to fill the gap. And these positions were specific for security and safety of our employees and staff. So we're trying to do the right thing here to expedite them getting filled.

Many of those positions, like the leadership position, should be exempt from that because there is, you know, we work for the mission of the organization, so I hope that helps.

So two years ago, and so we're still in a reorg for our Department and separated out the division, so we wouldn't be able to use those real dollars until 2027. If we do the formal process, which, by the way, we have. We have done so, the default is we're going to make them civil servant.

The process is taking an enormous amount of time.

All right, thank you.

I also want to follow up because we do have one position in developmental disabilities. You have a question about that position?

Morning, Chair, Committee Members. My name is Ryan Lee, Acting Administrator for Developmental Disabilities Division. This is a new position for us, so we have no history with it. We're requesting support.

Thank you.

Thank you. If there aren't any questions, let's move on to the next bill, which is House Bill 1542, which would allow terminally ill patients and qualifying patients over 65 years of age to use medical cannabis. In certain healthcare facilities. First up, Department of Health.

Morning chairs, vice chairs and Members, Andrew Goff of the Office of Medical Cannabis Control and Regulation. This bill would essentially require the majority of facilities, healthcare facilities in the state, to allow patients that are terminally ill and patients over 65 with chronic conditions to use medical cannabis at the facility. There are some limited exceptions.

The issue is now, first, I want to make sure that it's clear that we support the intent of this bill. Medical cannabis can be extremely effective for treating end of life conditions and easing end of life transitions both for the patient and for the families. The ultimate issue is the federal law is not there yet.

While the President has indicated a desire to move Cannabis from Schedule 1 to Schedule 3, which would recognize the medical value of cannabis, we do not yet have a timeline for when that will happen. We don't have a process for how that will happen, and we don't know what that will eventually look like.

So our recommendation at this time is to change it from a requirement to an authorization under state law so the facilities can, under state law, allow the use of medical cannabis for these conditions, but are not required to violate federal law if they choose not to.

I do want to note that last year, with the help of the folks in this room, we were successful in expanding the medical cannabis program to allow for hospice providers and palliative care providers to certify patients for medical cannabis cannabis.

And as part of the rulemaking process, we are going to be doing outreach and education for those providers to let them know what the rules are, what the law is, and to address any concerns they may have of medical cannabis in their facilities.

So I do want to thank the committees for engaging in the discussion and for supporting our patients. And I'm here for any questions you may have. Thank you.

Mr. Groff. Office of the Attorney General on Zoom.

I'm in person.

Okay, here you are.

Good morning, Chair, Vice Chair, Members of the Committee, Alana Bryant, Deputy Attorney General. I'll briefly highlight the comments in our testimony. The comments are very similar to what Mr. Goff just stated. We note that at this time, cannabis is still a Schedule 1 controlled substance under federal law.

And because of that, we recommend making accommodation of medical cannabis in health care facilities permissive rather than mandated. We noted that the President did sign an Executive order in December 2025 directing the U.S. Attorney General to reschedule cannabis to Schedule 3, which may reduce the legal risk to healthcare facilities.

However, we don't have a time frame for when rescheduling might actually occur or what rescheduling would actually look like. Thank you. And I'm available for any questions if you have them.

Thank you very much. Let's see. We have testimony in opposition from Hawaii Substance Abuse Coalition and Big Island Substance Abuse Council on Zoom. I believe we have Hawaii Cannabis Industry Association. Tai Ching.

Good morning, Chair, Vice Chair, Members of the Committee, if you can hear me, my name is Tai Cheng, Chairman of Hawaii Cannabis Industry Association, and I'm here today in support with comments of HB 1542. This bill is about compassion and timely access to care, especially for terminally ill patients and seniors with chronic conditions.

And for these patients, medical cannabis is not experimental, nor is it recreational. It's a proven tool to help them manage their pain, appetite loss, and anxiety. At the federal level. The Attorney General has already mentioned that President Trump has directed the rescheduling of Cannabis to Schedule 3 under the CSA.

This is where Tylenol with codeine is also categorized. This reflects that growing consensus that there is medical value to cannabis and that the safety profile is comparable to many commonly prescribed medicines. Despite this recognition Medical cannabis patients in Hawaii, particularly the elderly and the terminally ill, still face delayed costs and burdens to get their medical cannabis.

HB 1542 allows for the medical use of cannabis in some health facilities, but timely access still remains an issue for this population. When someone is facing a terminal diagnosis, access should be immediate and not days away. No patient should be forced to wait, suffer or navigate the bureaucracy of receiving a 329 medical cannabis card.

I asked the Committee to consider the proposed amendment to allow for instant access only to the terminally ill and to patients over 65 with chronic conditions. The same way that a patient can receive a prescription for medications like Tylenol. With coti, a physician's qualification would still be required.

Medical cannabis cards can be delayed two to seven days currently from the Department of Health, and so we believe this amendment would greatly help with this law. I respectfully urge the Committee to pass HB 1542 with amendments. Thank you for your time.

Thank you. Also on Zoom, I believe we have akamai cannabis consulting Dr. Clifton Otto.

Good morning Chair, Vice Chair, Members of the Committee, Dr. Clifton Otto offering comments. Thank you for the opportunity to testify on this measure. You have my written testimony that I'd just like to briefly summarize.

This is a very important bill because it gets to the heart of why we even have medical cannabis program which is to allow the compassionate medical use of a botanical drug substance by those who are suffering with debilitating medical conditions.

The problem is that despite the authority that states hold over the intrastate practice of medicine, medical cannabis patients and dispensaries must violate federal law to participate. Changing shall to May is not going to fix this problem.

We need solutions like the one offered in my written testimony to reharmonize the state and federal regulation of cannabis in Hawaii so that patients can have access to commercially available medical cannabis products that do not put health care facilities at risk of also violating federal law.

Honestly, these solutions should be coming from the office of the Attorney General. Luckily, I believe we have the Deputy Attorney General for the Office of Medical Cannabis Control and Regulation here today. So let's figure out how to make this bill fulfill its purpose. Thank you for considering my testimony and I will be available for any questions.

Thank you. Health Care Association of Hawaii, Paige Choy on Zoom.

Thank you so much Chairs, Vice Chairs for the opportunity to provide some comments on our testimony. We are opposed to this measure. We are not opposed to based on, you know, we do feel like patients should have access to compassionate care, but our facilities, our members are very Concerned about the potential consequences of passing this measure.

I want to note that this measure is not just about hospitals. It's about all inpatient settings. So that also includes our skilled nursing facilities. I would say that it's likely almost 100% of residents in our skilled nursing facilities are Medicaid or Medicare recipients.

So it's extremely important for those facilities, along with our hospitals and our hospices, to comply with federal law. We understand that there are purported safeguards in the bill. Those safeguards are not, I think, strong enough to protect our Members from potential federal action if they do allow the use of cannabis in their facilities.

And we also have some clinical concerns right when you go into a hospital, you are not allowed to bring in your medications. The medications that you use are highly regulated isn't the right word, but essentially right. We know exactly what patients are on.

And so if there is an alternate substance that's being used and there's a clinical outcome that's negative, that puts our Clinicians in a really difficult position, but where they're having a hard time with their medication management.

So I do want to again really emphasize that we understand that patients should have access to compassionate care, but we do remain opposed. We do not feel as if the safeguards in this Bill are strong enough to protect our Members from potential federal action. So thank you and I'm available for questions.

Thank you. The On Zoom Marijuana Policy Project Karen o' Keefe Aloha.

I'm Karen O'Keefe, Director of state policies at the nonprofit Marijuana Policy Project. We are grateful to the chair for proposing this legislation to allow terminally ill patients and Kupuna to use medical cannabis in healthcare facilities.

Patients do not have to give up a natural medicine that they depend on to manage their symptoms when they need care in a facility. As others have noted, including in written testimony, California passed a similar law in 2022 and it's been implemented and we have not heard of any federal law issues.

While we strongly support the intent of this bill, there are a couple of provisions where we're concerned that it actually may require facilities to ban conduct that they currently allow, and we'd urge those to be amended. First, we're concerned that HB 1542 prohibits acute care hospitals from allowing non terminal patients from using medical cannabis, not any form.

We strongly support urge you to revise this so it simply wouldn't require hospitals to permit medical cannabis except when intended to. Second, the bill requires health care facilities, including nursing homes, to ban cannabis vaporization and smoking under Hawaii Smoke Free Law There are exceptions for nursing home rooms if the room's residents requested a smoking room.

And unlike tobacco, smoked and vaporized cannabis has medical vet benefits. Inhalation allows for precise dosage titration and immediate relief, which is crucial to relief. Nursing homes should be allowed to, if they wish to, smoking and vaporization, vaporization in private rooms. Thank you.

Thank you. Drug Policy Forum of Hawaii.

Aloha. Aloha Chair, Vice Chair Members Nicholas Leverenz with Drug Policy Form of Hawaii. We strongly support this bill and we're grateful to the Chair for introducing this in alignment with Ryan's Law in California.

Largely, however, we do think that medical cannabis should not be subject to more severe restrictions than smoked tobacco in healthcare facilities, given the relative lack of therapeutic benefit of smoked tobacco for those who are terminally ill or living with chronic diseases.

In short, we believe that the bill should be amended so that cannabis is not treated more restrictively than smoked tobacco. And we're hopeful that you're be able to take this amendment.

We also, you know, will note that California's law has operated quite well since it was implemented and that if this is turned into a permissive bill as recommended by Mr. Goff with with the expectations that he provided education to providers, then it will be an effective null, especially given the Department of Health's record in not providing science based information to existing medical cannabis patients.

Mahalo for the opportunity to provide testimony.

Thank you. Robert Bentz on Zoom.

Aloha Chair this is Robert Bentz. I might be the only one that has actually been in hospitals with this exact patient same problem. So I mahalo you for introducing this bill. I would like to echo the concerns of MPP and the Drug Policy Forum and I offered written amendments to please. Include. Number three under patients.

least for those of us that are severely disabled and without the cannabis we would die. I've had many, many doctors tell me that cannabis is the only thing that treating my seizures. And the Stanford seizure specialist told me that the hardest problem with cannabis is staying consistent.

So if I had to go into a hospital and stop my cannabis, I would have a seizure. I would have more severe disability than I already have. I had to learn how to walk and talk and swallow and everything again after a birth defect caused the brain surgery.

I was in a rehabilitation hospital in California with several seniors. But there are those of us that are under age 65 that if we had to stop it, we would die. So if you could please consider my amendments.

Also seeing the testimony and concern about federal illegality, there is already a law passed I emailed this to you last night. I would offer the following amendment to please include patients in a state approved study in compliance with the Medical Marijuana and Cannabinoid IO Research Expansion Act. H.R.

8454, Public Law 117215 signed into law December 2, 2002 by President Biden, streamlines the DK.

Mr. Bentz, we have your written testimony.

So we have. Thank you. This would streamline the DEA process. So it's very important and I agree that if you change it to May and Shall, it's a worthless bill. So please let us work with the federal authorities under current federal law that allows it.

Thank you very much for your testimony.

Let's see, we have written testimony from three other individuals offering support. Anyone I missed wishing to testify on House Bill 1542? If not questions, Members? See, I do have a question for the Healthcare Association, Paige Choy on Zoom. I know in your written testimony, in your testimony you expressed opposition to the bill.

I'm just wondering if we adopted the issue. I just wondered if we accept the proposal to change shall to May, would that alleviate your concerns or opposition?

I think it would alleviate.

I'm sorry, go ahead. Thank you.

Thank you. I think it would alleviate a lot of our concerns. I would note. Right. There's been a lot of discussion about the potential reclassification and so.

So the suggestion to have more of a partnership with Department of Health in particular to do an education campaign, especially if cannabis is reclassified, I think is one that we would really appreciate. Clearly this is an important issue and I think it's one that our providers would appreciate.

I think a formal partnership on education with our practitioners, with our Clinicians on. So if there was a change to permissive, I think some requirements about those partnerships for education would also be welcomed.

Okay, thank you very much. There being no other questions.

Thanks for being here. In addition to the Chair's question, we had a letter from Big Island Substance Abuse Council regarding exempting drug treatment within hospital, but it does not explicitly exclude residential treatment programs. Could you expand a little bit on that?

We do not represent the residential treatment programs. So I can take a look at that letter and contact the appropriate folks at our hospitals, see if they have any insights to address that concern and I can get back to the Committee.

Great. Thanks, Paige.

Yeah, thank you. If there aren't any other questions, let's move on to the next bill on the agenda, which is House Bill 1573, requiring electronic smoking devices and e liquid manufacturers to certify to the Department of the Attorney General that the manufacturer received a federal marketing granted from the FDA. First up, we have the Attorney General.

Good morning, Chair, Vice chair, Members of the Committee. My name is Chelsea Okamoto. I am a deputy Attorney General and unit supervisor for the Tobacco Enforcement Unit. Thank you for the opportunity to testify and thank you, Chair, for introducing and leading this bill and for Members of this Committee who also co sponsored this bill.

Our Department is in strong support of this bill. The vaping industry has intentionally targeted our youth and saturated the market with highly attractive products. The Tobacco Control act granted the FDA power to regulate these e cigarettes. And as of today, the FDA has only authorized 39E cigarette products for marketing and sale in the United States.

The FDA has clearly stated that these 39 products are the only products that may be lawfully sold in the United States. Yet we still see a number of these unauthorized products on our shelves. Over the last year, our Department has made an active effort to educate retailers and distributors about the list of these authorized FDA products.

We've mailed out hundreds of letters to the retail permit holders and faculty licensees, including updating them whenever there's a change to this list by the Fda. And we've also updated our website with these retailer resources. So we've laid this groundwork to educate and raise awareness.

We've essentially set the table and now we're asking the Legislature to pass this Bill to give the Department the tools needed to enforce. So this Bill creates a directory. It runs parallel to and in lockstep with the the FDA's authorized list. It creates a certification process that manufacturers need to abide by to participate in Hawaii's marketplace.

It gives the Department inspection hours to enforce the directory rulemaking abilities and penalties for manufacturers that don't comply with this process and penalties for parties that sell the products not listed in the directory. These penalties will go back to help Fund the enforcement of this directory. We ask you to pass this Bill. And thank you.

Available for questions.

Thank you. State Office of Information Practices offering comments, if I may. For the. It's out of order, but for the Deputy Attorney General. Just wanted you to look at, if you can, the OIP suggestion that we delete subsection D on the top of page three. So could you take a look at.

So Office of Information Practice did reach out to us to notify, and it was their testimony also submitted in SB 1525 last year. We'll defer to the Office of Information Practice since this is their area of expertise.

Okay, thank you very much. Department of Health.

Good morning. Lala Irvin for the Department of Health. Thank you, Chair Takayama and Chair Mata and Members of the Committee. So the Department of Health would like our youth to have just the best health possible. And we work on education and we know that our youth, our young children are using E-cigarettes.

And so we're working on education. We actually have cessation programs for them called My Life, My Queen. We also know that young adults are using them. So we have the Hawaii Tobacco quit line, which is also now providing services for those who are using E-cigarettes.

And we have a new campaign out now to especially reach out to young adults. That is not enough. So as the Deputy Attorney General mentioned, there are 39 products that have received the money marketed granting orders from the FDA. There are over 6,800 of these E-cigarettes still out in the market.

And what we do not have in Hawaii is the enforcement ability. And so we're state, we're not the Federal Government, and so we can't enforce their laws. And so the problem we have is while we know that there are only 39 products that receive federal marketing orders as a state, we can't confiscate them.

So Department of Health can't say, oh my goodness, these aren't allowed. You need to take them off the shelf. And so to provide the state Attorney General's office with the authority to then fully investigate and also then enforce the laws is what we need because we're on the balance. We have the education, we have the Quit Support.

22% of our young adults age 18 to 24 say they currently use E cigarettes. 25%, 25 to 34 year olds say they use. So those are the young people that started in high school. They're still using it at a very high. We're also getting requests from elementary schools.

So we really need help to get these products off the market. And so we appreciate the Attorney General's support behind HB 1573. Thank you so much for introducing this bill.

Thank you. Dr. Jack Lewin.

We stand in strong support. Officers, Vice Chairs. We stand in strong support. Same. Thank you.

Hawaii Public Health Institute. Kevin Ramirez.

Good morning, Chairs. Vice Chairs and Members of both. My name is Kevin Ramirez. I'm the program manager for the Coalition for Tobacco Free Hawaii, which is a program of the Hawaii Institute. I want to thank you for hearing this bill and the opportunity to testify. I'm here to testify in support of HB 1573 relating to health.

So in the nine years that I've been working with the coalition, part of My role and responsibility has been coordinating the 808 no vape campaign. And the 808 no vape campaign is providing vaping prevention education to schools across the state. I have spoken to thousands of students most recently in the last three years.

All of those students have been majority elementary school students. So what I can tell you is the vaping problem still persists in our communities and in our schools. What I can also tell you is that the vast majority of E-cigarette products that are driving the vaping problems in our communities and in our schools are unauthorized.

And what unauthorized basically means is illegal. The Federal Food and Drug Administration is the agency tasked with regulating tobacco products. And they only have 39 products on their authorized list. And one of the reasons they only have 39 products products on that list is because they have rather stringent criteria when they evaluate E-cigarette products.

What they're really looking for is if an E-cigarette product is going to be a benefit to public health. And what that really entails is is this product going to be something that an adult smoker would switch to using so they can quit smoking combustible cigarettes.

The other half of that criteria is, is this E-cigarette going to appeal to youth? And if it appeals to youth, it doesn't make the list. So HB 1573 will sweep our state market from all these unauthorized products that are driving the vaping epidemic and empower our state Attorney General's office to take enforcement actions.

So thanks again for the opportunity to provide testimony and support of HB 1573.

Thank you. Let's see, we have Lanai Community Health center expressing support. Support Hawaii Smokers Alliance in opposition. In addition, we have written testimony from, let's see, a dozen individuals in support and three in opposition. Anyone I miss wishing to classify on this bill, if not Members, questions for.

The Department of Health.

So I see that this bill would. Give you folks more or give you. Enforcement tools we don't have. Obviously that takes humans people to go and do it. Would you be paying for that staff with the fees collected or how would you actually execute this? Or do you already have the capacity?

Chair Marten, that is an excellent question. And we have exactly the right person and the partner in the room and we're actually working together. So may I have your permission to call up Deputy AG Chelsea Okomara? Thank you. Because we're actually working together on that issue.

Thanks, Lola. Thanks, Chair Martin, for the question. So the Department of Attorney General is going to be tasked with the enforcement of this directory. So we would manage the directory, post the directory and we would also be the ones tasked with also enforcing it.

We do already have tobacco inspectors who are already out in every tobacco retail location making inspections. And so they're already there doing that function. And so to put this directory in their hands as a tool, it makes it very easy for them to start doing enforcement in this new space of E-Cigarette.

I've spoken to our investigations division and they're willing to take this on without having appropriation from the Legislature. That being said, the way the bill is structured, there are civil penalties that the manufacturers do not follow the process of certifying their products. And there are also civil penalties when someone is caught selling these products.

And those will go back to fund the functions of enforcing this directory. So hopefully it's self sustaining. We haven't tried it yet, so hopefully next year we'll have a better understanding of what it costs to do this. But right now we do already have people in place to try to take this on.

If I may add to that to the partnership. So through our attorney general's office, there was a settlement with Altria, the 33% owner of Drill. And so the Department of Health is responsible for those funds.

And the tobacco enforcement unit, besides being here and enforcing what is happening in the marketplace, they also delegate gently enforced tobacco master supplement agreement.

And so in order to support what they're doing with the E-cigarette side of things that's happening now, we are actually have a memorandum of agreement and we're supporting what they're doing with the E-cigarette situation and the inspections. And so I think that fund is going a long ways to get them started.

And then of course, you know, as they look at the fines and citations, hopefully then that will be something that will continue to be sustainable.

Thank you very much.

Thank you. Any other questions? If not, let's move on. Next bill is House Bill 1704 adopting the psychology Inner Jurisdictional compact. And first up we have Dr. Jack Lewin

Thank you, Chair, Vice Chairs, Members, we stand by our testimony. Thank you.

DCCA Board of Psychology.

Good morning. Chair Takayama and Chair Marten. For not identifying the Committee and yourself in the heading of the board's testimony, I sincerely apologize. My name is Christopher Fernandez, Executive Officer for the Board of Psychology. I'm here to offer comments on the bill on behalf of board.

The board just wanted to note that it has submitted testimony for previous iterations and other legislative sessions. They continue to be unable to identify information regarding enforcement costs related to the compact. The board would have to establish FBI background checks so that would be working with the FBI themselves.

There's certain educational requirements to join the compact and this may limit the board's authority to determine degree requirements here in Hawaii for our own licensees. The types of doctoral degrees in psychology that we currently accept, clinical counseling and school psychology, we may be needing to accept a larger number of those types of doctoral degrees.

And lastly, I think that the board has also just identified sociocultural factors that may contribute to the quality of services. And then also there may be a fiscal impact regarding license fees being received. Thank you. And I'm here available for any questions. Thank you, Mr. Fernandez.

And actually no apologies in order because it's actually the first two bills that were a joint Committee. The rest of it is. The rest of it has been just Committee. So thank you. State association of Counties.

Aloha Chair, Vice Chair and Members of the Committee Nahilani Parsons here on behalf of Hawaii State Association of Counties in strong support of this measure. Just want to thank the Committee for hearing this. Our membership includes council Member from each of our four counties, including all of our council chairs.

And we're trying to address the shortages and move rural health needs of our underserved communities. So appreciate this measure. Thank you. Thank you.

Hawaii association of Health Plans. Rachel Wilkinson.

Good morning. Chairs, Vice chairs, Members of the committees, Rachel Wilkinson on behalf of the Hawaii Association of Health Plans in support. As you know, Hawaii continues to face a shortage of mental health professionals, particularly on the neighbor islands and in our rural communities. So we appreciate the compact's ability to increase mental health services. Statement.

Thank you for the opportunity to testify.

Thank you. Let's see. HGEA Randy Perer in opposition on Zoom. Aloha Care. Mike Nguyen not present. He's in support. Anyone I missed wishing to testify on. House Bill 1704. If not Members. Questions. Okay, seeing none. Let's move on. Next bill we have House Bill 1996 which would exempt from the General excise tax hearing aid purchases.

First up we have Department of Taxation.

Good morning. Chair Vice Chairman of the Committee Robert Avila on behalf of DOTAX, please stand. On our written testimony providing comments to summarize, we're just recording. Requesting that the active date of the. bill be amended from July 1, 2026 to January 1, 2027 to provide sufficient time for form and instruction changes and to inform taxpayers of the nations.

Okay, thank you. Disability and Communication Access Board and support Tom Yamachika, Tax foundation of our EON Zoom.

Thank you. Chairs.

Members of the Committee is Tom Yamachika from Tax foundation of Hawaii we sub written testimony which basically says we are wondering why hearing aids are being singled up for special treatment while over the counter auditory, I mean ocular or dental health materials are not currently exempt and would continue to be non exempt under this bill.

That's the only anomaly I wanted to point out. Thank you very much for the opportunity and I'll be available for questions.

Thank you. Also on Zoom, Peter Fritz.

Thank you. I've been unmuted. My name is Peter Fritz. I'm an individual with disabilities and a person that also uses hearing aids. In terms of why it addresses hearing aids, it's because many years ago I paid $127 for of GE tax when I purchased hearing aids and I drafted a bill.

I agree with the Department of Taxation suggestions about changing the effective date. I think that it's the right way to do it. And my testimony focused also on the fact that making hearing aids more affordable will help forestall or has been shown in studies.

And anybody that would like to see some of those studies, I have them in my research file. Dementia. It also reduces trips to the emergency room because people aren't surprised when somebody comes up behind them and can hear them. And so I would respectfully ask that the Committee move this forward. Thank you for the opportunity to testify.

Thank you, Mr. Fritz. Let's see, we have four individuals submitting testimony in written form and support anyone else wishing to Testify in House Bill 1996. If not Members. Any questions, seeing or hearing? None.

Let's move on to House Bill 1547 which would provide a tax credit for qualified taxpayer insurers that offer one or more federally qualified health savings account eligible health plans. And first up we have Department of Taxation.

Good morning Chair, Vice Chair, Members of the Committee, this is Robert Avila. On behalf of DOTAX, we stand on our written testimony providing comments. To summarize them, we recommend that the bill be amended to include a five year time limit to claim any credit card forward as credits claim further from the year in which they are incurred.

The expenses are incurred are more difficult to verify. We also note that it is administratively difficult for us to administer aggregate caps. So we would request that the certification for any tax credits be handled by a third party.

The rest of our comments really relate to some of the definitions in the Bill that we think could provide a little more clarity and allow us to make the Administration a bit easier. For example, terms like rural, terms like written in a policy being written in Hawaii.

Having more clarity around what these terms precisely mean would allow us to better administer this bill.

And then finally, DOTAX would like to note that we would have trouble enforcing the bill's health savings account matching provision since we would need to determine the amount of a policyholder's first time contribution and then compare that to the qualified taxpayers claim tax credit amount.

And then as with the other bill, we would just recommend that the so that the effective date is moved for taxpayers beginning after December 31, 2026 that would allow us to prepare forms, make system changes necessary rules and inform taxpayers of the new tax code. Thank you. You're answering the questions.

Thank you very much. State Department of Labor and Industrial Relations submitted testimony offering comments on Zoom. Tom Yamachiko, Next foundation of Hawaii.

Thank you. Chair, Vice Chairs, Members of the committees, Tom Yamachika from Tax Foundation. We are primarily concerned because there are blanks throughout the bill that contain important information. We would strongly urge the community to fill these in before moving the bill forward. We believe that's what's required under Mason's manual.

So we look forward to continuing the conversation once the blanks are filled in. Thank you and happy to answer any questions.

Thank you. Hawaii Medical Association.

Aloha. Chairs, Members of the Committee. Nasio Hawaii Medical Association. We stand on our written testimony and. Support with comments available for questions. Thank you.

Thank you very much. See we also have written testimony and support from Dr. Robert Thomas Carla. Anyone I missed. Anyone else wishing testify on bill 1547? If not Members questions? Seeing none, let's move on to the final bill on the agenda which, Ah, okay.

House Bill 1563, which would repeal the existing law that preempts local ordinances or regulations that regulate the sale of cigarettes and other tobacco products. First up, the office of the Attorney General.

Again chairs, vice chairs and Members of the Committee, Chelsea Okamoto, again, Deputy Attorney General and unit supervisor of the Tobacco Enforcement Unit. Thank you for the opportunity to testify on this bill. You have our written testimony. Our departments in support of this bill. Chapter 328, Section 11.5.

It's a statute that currently preempts and prevents counties from enacting ordinances or regulations associated with tobacco sales, including the sales of E-cigarettes. And so the Department supports restoring this authority to them to adopt more stringent tobacco control measures and to regulate tobacco products.

In our testimony we raised the concern that the Bill may inadvertently limit counties who already have the existing authority to regulate smoking. So we suggest adopting the approach as an HB 1117, which is just to repeal 328J in its entirety.

Or alternatively, we outline to amend page six, lines 13 and 19 to add wording to explicitly allow them to have the authority to regulate smoking. So we ask the Committee to pass this Bill with our recommended admissions. And thank you for the opportunity to testify. We're here if you have questions.

Thank you. Department of Health.

Good morning, Little Urban. Good morning, Lola Irvin, with the Department of Health. Thank you, Judge Takayama and Marten. And thank you Members of the Committee. Thank you. Very much for introducing HB 1563. This is in line with the Department of Health's value of engaging with the community.

And to do so we do outreach, we provide funding for coalition building, we provide education, training and unfortunately with the introduction to Act 206 Part 2 and the insertion of 328J 11.5, well, we have engaged communities and we provided them with data and they know more about their communities and what's happening.

We've taken away the ability for them to pass more restricted laws and regulations at the county level. And prior to 2018 the counties were very innovative in addressing the needs.

And so we do have in our testimony a list of the things that they've done like smoke creek cars when cakings are in the car, smoke free beaches, even our smoke free laws started at the county level before it became state level law.

And so the repeal of 328J 11.5 would then return the county's right to be able to protect their K fee. So thank you for the opportunity to provide testimony.

Thank you very much. Dr. Jack Lewin.

Good morning again Chairs, Vice Chairs, Committee Members. We support and echo the comments we've just heard from the AG and from Department of Health. Thank you.

Thank you.

Let's see, we have statements of support from Hawaii County Council Member Jen Kagiwata, Hawaii Substance Abuse Coalition, Hawaii copd co. Sorry, Hawaii Public Health Institute, Keith Ramirez.

Aloha. Good morning again Chairs, Vice Chairs and Members of both committees. Kevin Ramirez here, Program Manager for the Coalition for Hawaii with the Hawaii Public Health Institute. Thanks again for hearing this measure and providing the opportunity to testify. I'm here to testify in strong support for HBA 1563 relating to tobacco products.

Historically effective tobacco prevention and control laws that protect our community from secondhand smoke, protect our youth from tobacco products have started at the local level. This was certainly the case in the late 1990s when our local county car coalitions were passing smoke free air laws and then the state adopted that some years later.

A more recent example is 2013 when Hawaii county passed a law raising the age of sale of tobacco products from 18 to 21. And in 2013 they were only the fourth jurisdiction in the country to do so.

Two years later, the state of Hawaii adopted that as a state law and raised the age of sale from 18 to 24. And then in 2020 that law was passed at the federal level.

So you can see that it's important that local jurisdictions have the authority to act quicker to protect their communities and the Tobacco industry is well aware of this and this is why that they've been trying to take county authority away from the counties nationwide. And in 2018, unfortunately that happened here in the state of Hawaii.

So for the last eight years, we've been trying to restore county authority to regulate tobacco products at the point of sale. And the counties want the authority back.

In fact, in 2023 and 2024, despite the fact that they don't have the authority to do so, Honolulu County, Hawaii County and Maui county all passed ordinances to end the sale of flavored tobacco products that unfortunately did not take effect on until county authority is restored.

So thanks again for the opportunity to testify in strong support of this measure. Mahalo.

Ma thank you. On Zoom Coalition for Tobacco Free Hawaii Youth Council, Luke Itomor.

Aloha Chair Takayama, Chair Martin and Members of the Committee. Sorry about the jump scare. I know you guys were expecting youth, but unfortunately he had to run off to class today.

But my name is Saya Shibata and I'm the youth coordinator speaking on behalf of the Coalition for Tobacco Free Hawaii Youth Council in strong support of HB 1563. For years, the Youth Council has worked alongside community advocates to end the sale of flavored tobacco across the state.

Because of their work, the city and county of Honolulu, the County of Hawaii and the county of Maui have passed bills to end flavored tobacco sales in their communities. By restoring county authority, these county pass laws can be fully implemented and enforced, allowing counties to better protect their communities.

As a youth coordinator, one of my responsibilities is educating students about the dangers of tobacco use. In every classroom, I first start off by asking them, is vaping a problem in your school or community? Nearly 90% of students typically raise their hands.

This shows that youth e cigarette use remains a serious issue and that stronger tobacco tobacco regulation and control are needed to protect our keiki. With federal tobacco funding eliminated, restoring county authority allows communities to respond quickly to emerging threats and prevent harm before it spreads. Please pass HB 1563. Thank you for the opportunity to testify.

Thank you. Also on Zoom American Lung Association, Pedro Haro. Not present. American Heart Association.

Good morning, Chair, Vice Chairs, Members of the Committee on Behalf of the American Heart Association, we stand in strong support of this measure.

You know, based on a lot of the comments you heard from DOH and HiFi, I think this is a policy that takes us in the right direction of preventing one of the most preventable forms of death in Hawaii. Right? Preventable causes of death.

So, you know, for those reasons, we stand in strong support and are available for any questions.

Thank you.

Thank you.

We have written testimony also from both the Hawaii Smokers alliance and Cigar association in opposition. I'll note that we have 11 other organizations in support. 50/50 plus individuals have submitted written testimony in support. I might note that one of them said they support regulating Tabasco, assuming that is a typographical error. And we have seven in opposition.

Anyone I missed who wishes testify on House Bill 1563? Okay, seeing none. Members, any questions? No questions. Oh, okay. Well, I believe we can now move on to decision making. Thank you all for your testimony. Members ask us to. Okay.

Okay. Sorry. Just bear with us for a minute while we get ready for our bullets. So, first up, we have House Bill 1969 relating to the colorectal cancer. This is a jointly referred bill.

I suggest we move this bill forward as a House draft deleting the FAQ section of the bill, which made reference to ACA FAQs that may be updated regularly. So testimony we received suggested deleting that we would still have the federal task force which fairly clearly specifies colorectal screening standards. So we'll delete the FAQ section of the bill.

Also add a defective date, an add in report language which suggests funding amount of $1.8 million a year and one position to administer the program. That's my recommendation. Members, any questions, comments or concerns? If not Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 196069. Chair's recommendation is to pass with amendments. [Roll Call] Recommendation is adopted.

Thank you for Human services.

Human services, same recommendation. Are there any questions or concerns? Then Vice Chair for the vote.

Thank you, Chair. 20 HB 1969 Chairs recommendations to pass with amendments. Any Members voting? No reservations. Chair recommendation is adopted.

Thank you. Next bill is House Bill 1965 relating to primary care providers. First up, I'd like to thank the Vice Chair of the Health Committee for introducing this bill after working with providers. Health providers on the Big Island I believe is a very important measure. One of the most important we'll consider this session.

And I think it would move our health system in the right direction, forward in keeping our primary care providers in business, especially in rural areas and both on Oahu and on the neighborhoods.

However, I believe that the state insurance commissioner raised some substantive questions about some details of the bill that I believe require more work on our behalf. I was particularly moved by the passionate support for this bill by the doctor, by the State Office, by SHPD, Dr. Jack Lewin.

And so I'm going to suggest that we form a working group under the terms of this bill. And the working group would be led by Dr. Jack Lewin, and it would be tasked with considering several of the points that were made in the bill.

Namely, the working group should consider, number one, setting minimum percentage expenditures on primary care reimbursements by health carriers. Number two, consider the issue of down coding and inappropriate modifications to submitted claims. Number three, consider new reporting requirements for health carriers. Number four, penalties for violations. Number five, possible creation of a primary care stabilization Fund.

Number six, give particular consideration for the needs of rural health area residents and providers. And finally, consider what federal approvals may be required to enact this measure.

The working group would be led by the administrator of Shipta, as I mentioned before, and the Members shall consist of five Members representing the insurance industry to be selected by the Hawaii Association of Health Plans, five Members representing licensed health care professionals, two of whom shall be selected by the Hawaii Medical association, two of whom shall be selected by the Healthcare Association of Hawaii, and one selected by the UH School of Medicine.

Jabs. I'm sorry. Members, bear with me because it's important that we specify this in the in the measure.

In addition, five Members representing consumers of healthcare or employers, two of whom shall be selected by the board of trustees of the Hawaii Employer Union Health Benefits Trust Fund, one of whom shall be a consumer selected by the Statewide Health Coordinating Council, one of whom shall be selected by the Hawaii Primary Care association, and one selected by Papa Ola Lokai.

Members of the working group shall elect the Chair and Vice Chair from among themselves. Director of Health Insurance Commissioner and Administrator of MedQuest Division of Department of Human Services shall each appoint an ex officio advisor for the working group.

Finally, Working group shall submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than 20 days prior to the convening of the regular session of 2027. Those are my recommendations, as well as adding a defective date to the measurement. Any questions, comments or concerns?

Thank you, Chair. First of all, thank you. I appreciate the wisdom of the direction you're taking this. I think oftentimes we're eager and swinging for the fences, but I also recognize there's a lot of substantive adjustments that have to happen and I think clearing that through the working group is the best course of action.

And I also do appreciate Dr. Nguyen leading that working group. And I just want to note something he mentioned in testimony which is we need to find a way to do it together. So thank you, Chair for that recommendation.

Thank you very much. Any other comments?

I just like to echo the comments by Vice Chair and also to all the testifiers today. This is the type of discussions we need in order to make good law and to help better how we do things in Hawaii.

And so I'm just proud to be part of that process and mahalo to everyone and the good decision that I believe is being made today.

Thank you very much. And also a lesson on you shouldn't leave the room. Also. Well, any other questions? If not Vice Chair for the vote.

On. Members on HB 1965. It's a recommendation of the Chair to pass with amendments seeing all Members present. Any reservations? Any noes? Chair, your recommendation is adopted.

And for the Human Services and homelessness Committee, also HB 1965, same recommendations. Are there any comments or questions? Seeing none. Vice Chair for the vote.

Voting HB 1965 Chair's recommendations pass with amendments. Any Members voting? All reservations, Chair recommendation is adopted.

Thank you. Let's move on to House Bill 1804 regarding long term Financing Advisory Commission. I'd like to move this bill forward. Legislative Reference Bureau in its testimony said it really lacked the expertise in certain areas that would be helpful to the commission.

So my suggestion is that we replace references to LRB with office of the Legislative Auditor instead. Because I believe that office has the resources and expertise in actuarial studies and this particular field of expertise. Also like to add.

Also like to add the recommendation from Healthcare association that we had a representative from the long term care providers to the commission. Finally, I'd like to delete reference to the $100,000 appropriation and put that in the Committee report instead. And I'm sorry. And finally added effectively Members. Any questions, comments or concerns seeing them? Vice Chair.

Thank you, Chair. Members voting on House Bill 1804. Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservations, Any voting? No, Chair, your recommendation is adopted.

Thank you. Next, bill 1976 relating to train training in dementia. I'd like to move this forward as the House draft incorporating suggested amendments from the Office on Aging regarding start dates and content of the curriculum. Also add a defective date and end date.

Also. Start date on the end date.

Well, yeah, I'm sorry. Start date and end date for the training sessions. Yeah. Thank you, Chair. Questions, comments or concerns? Vice Chair for the vote.