House Standing Committee on Health

Good morning, everyone. Welcome to this hearing on the House Committee on Health. Just so everyone knows where we are and, well, at least where you are. This is Friday, February 6th, 9:00am in Conference Room 329. And as I said, this is the Committee on Health.

Several bills later on will be a joint hearing of both this committee as well as the Committee on Human Services and Homelessness, chaired by Representative Lisa Marten. So just some housekeeping, you'll notice that our mics are live, but there are no mics. The mics are upstairs, are in the ceiling with those green lights.

And so we'll ask that when you testify that you speak at the podium in a clear, distinct voice. And for audience members, I'll remind you that the mics can pick you up as well. So if you say nasty things about the speaker, everyone will hear on YouTube and elsewhere.

So also for those on Zoom, a reminder to keep yourselves muted until you're called up and also not have any trademarked items visible. We have 15 bills before us this morning, so I'm going to ask that testifiers try and limit themselves to two minutes, if at all possible. We do have a timer that will ring. And we won't rush you to the ground if you go over, but we'll just ask that you, you know, try and keep it to two minutes.

So with that, let's move on to our first bill, which is House Bill 2315, relating to vacation fund payout pilot project for the Department of Health. First up, we have the Department of Health.

Good morning, Chair, Vice Chair, and Committee Members of the Committee on Health. Chair, Vice Chair, and Committee Members on the Human Services and Homelessness Committee. My name is Bobby Robinson. I am the Departmental Human Resources Officer for the Department of Health.

And I am here to testify in support of HB 2315, as it authorizes the Department of Health to establish a vacation payout pilot project in which eligible Department of Health employees may prefer unused vacation leave credits in favor of a payout to provide home purchase down payment assistance. Questions or any areas of clarification if needed.

Thank you very much. HGEA, please step forward. Oh, you can, you can sit down. Thank you. We'll have questions of testifiers after all the testifiers have testified.

Good morning, Chair, Vice Chair, Members. Nui Sabas of as for HGEA. We're in support of this measure and we'll send out our testimony in support. We do want to just highlight that this is a, this can be a unique and creative benefit offered to the department employees, which we think could help with recruitment and retention and also helping department employees become first time home buyers. We're happy to answer any questions. Thank you.

Let's see, we have United Public Workers.

Good morning, Chair, Chairs, Vice Chair, Members. Kamakana Kaimuloa, United Public Workers. You have a written testimony in strong support of this bill. But I'd like to highlight a few points. The pilot program proposed in this measure to us demonstrates an employer who is trying to pursue alternative cost effective ways to recruit and retain employees.

It also shows us that the department may also understand the needs of working people in Hawaii and what may motivate them to work for the department or continue working for the department. Admittedly, we can't say how many of our members would necessarily utilize the program, but we think, but we strongly believe it could be a huge success.

And there's our hope that that success will be expanded. The pilot program like this or similar to this would be expanded to other departments and agencies. We would like to commend the department for a pilot program like this, as the exclusive representative for DOH employees in bargaining units 1 and 10.

We will admit that we will not and do not see eye to eye with the employer on, well, most of the time. But we can agree on this measure, and if for no other reason, we think that should be enough justification for the Legislature to pass this bill. I'd be happy to defer any questions to HGEA if you have them.

Thank you very much. I'm sure DOH appreciates your commendation on the record. So. Well, let's see. That's all the testifiers we have on this first bill. Anyone I missed who wishes to testify? If not, Members, questions? Seeing none. Let's move on.

And I will add my commendation to the Department of Health for attempting again a new pilot project to help recruit employees. So thank you very much, Mr. Robinson. This next bill, House Bill 2562, relates to workplace violence in healthcare settings. First up, Department of Health.

Good morning, Chair, Vice Chair, Members of the Committee. Lorrin Kim, Planning and Policy Officer for the Department of Health. We will stand in our testimony recommending the Legislature mandate licensed hospitals to have policies and procedures to prevent and mitigate workplace violence and also public reporting.

We think that's more cost effective alternative that would be equally effective or more so than us standing up a new state program. So I'll be available for questions. Thank you very much for hearing our testimony.

Thank you. Department of Labor and Industrial Relations.

Good morning, Chair, Vice Chair, Members of the Committee. Bill Kunstman, Deputy Director, DLIR. We'll stand on our testimony appreciating the intent of this measure and will be available for questions. Thank you.

I just might note that your testimony notes that the existence of HIOSH in terms of workplace issues.

Having some jurisdiction and responsibility in this issue. And I have subject matter experts here, should you folks have any questions.

Thank you very much. Hawaii Nurses Association. Welcome.

Chair, Vice Chair, Committee Members, thank you for the opportunity to speak up. For us, you know, as healthcare workers, I know there's other procedures that were talked about that are in place. But we're experiencing life and, you know, we usually speak up when we have to. And when it happens, you don't have two weeks, three weeks to wait.

We need it immediately, and we've been asking for it. You know, as nurses, I've been in a couple of contract negotiations, and it's a very slow roll. And I've heard so much testimony from nurses, and I wish I could share it today, but just know that we ask. So that's why we're here. And we want it. We need it up here. Because you know what?

It's not just the healthcare workers. We're speaking up because it helps our patients. It helps anybody that's inside that facility. Because if we speak up on it, that means there's problems, there's danger, and there needs to be something fast. We've tried HIOSH. We do different things, but it's not, it's not where he needed to be.

And it's already happening across the country where there's problems in hospitals and something happens. We do not want that here in Hawaii. It's enough out there in the streets. But to have it in your facility, that's something to be worried about. So that's why we're here. Want to speak up, just want to bring everybody's attention to it. Thank you.

Thank you. Let's see, we have Megan Reinhardt.

Aloha, Chair Takayama and Committee Members. My name is Megan and I'm a registered nurse at Kapiolani in the pediatric ICU. I've been a nurse for seven years, and I strongly support this bill. This past year has been the most challenging of my career, and I and my co-workers have faced sexual harassment and verbal threats, both in person and online, with greater frequency.

We have done everything we can by reporting it and alerting our superiors, but it is not enough. They are not protecting us. Inappropriate language and asking nurses out on dates, to even mentioning they can get guns to push their way has also feeling left us feeling unsafe in our workplace.

It has gone so far that even threats of doxing us online. It's affecting our lives both at work and at home. I came to a point where I was afraid to participate with my Halau and the community out of fear for my hula sisters and my safety.

My concerns fell in deaf ears and took months for action to actually happen. But it was too little too late. This bill would protect workers who speak up and require hospitals to take real action. Because right now, I feel unheard and alone. Please pass this bill and help protect us.

Thank you very much. Let's see, we have statement of support from the Hawaii Primary Care Association, as well as the Hawaii American Nurses Association. Comments from Queen's Health System and the Health Care Association of Hawaii. And written support from, let's see, 7 other individuals. Anyone else I missed who wishes to testify on this bill? Members, questions? Chair Marten.

The Nursing Association. I wanted to understand better what actions can be taken that are not already taken that would help.

So, you know, sometimes there's just things on paper, right? It's just making sure that if it's being said it's done, that there is... What is it, when you keep people accountable, when you keep employers accountable. That they have it, it should be done. And if it's not being done, what can we do about it? Right? Like we ask and it doesn't happen. So who's gonna do that?

Who's gonna take care of all that? So we felt like it had to go to a higher level, right? That's what we're taught. If it's not being taken care of, you have to go at a higher level. With, I know there's like the HIOSH and reporting it up and getting it, but when you live it, when you're there and there's an issue and it's you or your co-worker, it's real.

It's not just something you see on tv. And then you worry because you're gonna end up on tv because it's gonna be something happen. So what has to happen is what's happening now is you have a bunch of nurses signing up together and saying, this is dangerous. That's what it's taking.

Yeah, so that wasn't really my question. I understand the problem. What I don't understand is the solution. Like the rules that they have now with OSHA and all of that, is it just enforcing those that are existing or is it new actions? And if so, what are those new actions?

I guess maybe like, if there's an enforcement then understanding. Because I believe that when we do ask, there's like kind of a confusion, and then there's a delay of what does that look like or who's going to be taking care of it. And I think the frustration is that it's a here and now.

So I think it would help if there was like, hey, get these things in place. This is the plan, it's done. But if it's not being followed, then we where there should be something that says, hey, you need to follow the plan that you put out. Because in some ways they say there's a plan, but we keep asking about it and nothing's being done. So. And that's in different areas. So.

Okay, thank you. Thank you, Chair.

If I could follow up with you. I noticed in the testimony from Queen's that they say that for their nurses and other staff that they have some kind of personal alarm system that can immediately notify security in case something occurs in terms of a threat. Are you aware of this?

Yeah. There's something we could press. But I think there was like something that happened where there was a shooting on the outside and nobody knew on the inside. And there was, it was like, what's happening? You know, there's violence on the outside and it's just right outside the door. I believe we try to address it and working through it, but it's stuff like that.

It's coming close. The violence is getting closer. Before, we never really saw a lot of gun violence. Now we're seeing it more and more and coming in the hospitals. I mean, there are probably things that are not shared, but for us, we know, and this is why we're standing here and saying we need something done.

Yeah, no, thank you. Question. Oh, I'm sorry. Any other questions from Members? If not, Department of Labor. Can I... You know, I read the testimony from Department of Health as to accreditation standards that are required in terms of safety that should be met by hospitals.

And I read your testimony to say under the OSHA laws, you could enforce workplace threats and injuries and threats to safety. So I guess my question is is there more that Labor Department can do to follow up on complaints specifically in the health care field?

Yes. So just to make sure I understand the question. So there isn't a specific standard for workplace.

They do not exist now.

So we would have to prosecute under the general duty clause, which is a high bar. However, when we reference about guidance and things like that, we can use those industry consensus standards to build a case for general duty clause.

In addition to that, we can also provide guidance to the industry in the form of directives, which we're not able to cite specifically on, but it does provide more guidance for the industry for what we're going to be looking for when we go do an inspection. It also provides guidance for our inspectors.

Do you inspect hospitals?

We do.

On... For what? OSHA violations, in terms of...

Correct. Regular safety and health issues.

Do they cover nurses as well in terms of patient care?

Yes. What do you mean by... I mean, it's a workplace. So, yes.

You heard the complaints from nurses about workplace situations that may involve threats or actual violence. Would you do something to address it should it come to your attention?

Yes, absolutely. Maybe if I could call up Hayash and be able to give you a more complete answer. This is Roy Taliai. He's the administrator for the Occupational Safety

Morning chair, Members of the Committee. Roy Taliai, Administrator so to answer the question, we do get complaints, and we do go out based on the complaints filed, whether it's nurses or housekeepers. We also do program plan inspections. So these are not based off of complaints.

So we do enforcement activities at the hospitals, nursing homes, healthcare. Okay. Do you receive complaints from individual nurses, such as the cases we heard about this month? I believe so, yeah. We receive complaints from any employee that wishes to file. We also provide whistleblower protections for those employees who fear retaliation for coming forward with complaints.

Okay, well, thank you. Thank you for being here. Okay, let's move on to the next Bill, House Bill 1532. zero, okay. This relates to the importation. Importation of large cigars and pipe tobacco.

Just for the benefit of listeners and audience, the author of the Bill has asked me to defer this Bill to give him the opportunity to work with proponents as well as the Department of Attorney General to refine the Bill because it doesn't achieve what the intended purpose was.

So I'll just announce at the outset that we will defer this Bill. But again, if anyone wishes to testify on it, ... will be happy to hear your testimony. So at this point, does anyone wish to testify on House Bill 1532?

If not, and with the agreement of Members, let's move on to the next bill. House Bill 1857, relating to a broad definition of qualified health care provider. As those of you who are interested in this bill, HB 1857, may have noticed, it's a very lengthy bill because it itself involves more than 300 pages of changes to more than 200 existing healthcare laws.

Now, because of that and other factors, I want the audience to know that I've consulted with the Senate Chair on this measure, which is being held, incidentally, right at this moment. And so I realized the difficulty in weighing through a complicated bill like this in two places.

So what we've agreed upon is to use the Senate Bill, SB 2491, as a vehicle for changing, enacting the changes proposed in this bill. So with that, I advise the audience that my intention is to pass this bill out without any substantive changes, simply defecting the effective date.

And that will enable us to consider the Senate Bill when it moves over from the Senate. So we will certainly welcome any testimony you may have. But this is my assurance that this is my plan for this bill. And in the process, I think will save numerous trees. So thank you very much.

Let's move on with the testimony on HB 1857. Anyone wishing to testify on this bill, please step forward. Okay. Thank you very much. Let's move on to the next bill. I'm sorry. Anyone... You wish to testify? Oh, please identify yourself and step forward. Thank you.

Good morning, Chair Takayama, Vice Chair, very long name like mine, Keohokapu-Lee Loy. My name is Jim Maliszewskyj. I'm President of Hawaii Association of Nurse Anesthesiology. I represent 128 members as well as 130 CRNAs in the state. And I just want to submit testimony. I know it'll be going to the Senate side as well.

We appreciate the efforts that have been put into this bill. It's been a multidisciplinary bill that's been evaluated through the Center for Nursing from 2022 to 2024. And I appreciate the work that went on the bill. I also support the intent of the bill. But we just had a quick question about an amendment to the bill, which I suspect is...

Regarding nurse anesthetists? Yes, we have that proposed amendment from you as well as the Hawaii Center on Nursing. So that will be considered, I assure you. Thank you. Any other? Yes, please step forward. And by the way, I wish to add my compliments to the Hawaii Center on Nursing for leading this effort to rewrite and update our laws. Please identify yourself.

Hi. Good morning, Chairs, Vice Chairs, and Members of the Committees. My name is Kaena Keao. I'm here on behalf of the Department of the Attorney General. I understand you're not going to be taking substantive comments, but I just wanted to let you know that I am here and available for questions, should you guys have any. Thank you.

Thank you. Please.

Good morning, Chairs and Vice Chairs. My name is Jennifer Bojanowski, and I'm a certified genetic counselor. Just would like to introduce myself. I stand on my testimony that we are fully in support of this bill with the exception of an amendment to remove the clause or physician assistants in Section 121, Section 451, k through 5, Hawaii Revised Statutes.

I'm sorry. You submitted that in written testimony as well? We have that.

And it's a joint submission with two of my colleagues as well, Lila Aiyar and Michelle Takemoto.

Thank you. Okay. I'm sorry. Go ahead.

I know that you folks have this, so you can, you can read it.

Okay. We will consider it. Thank you. Anyone else wishing to testify? Okay. If not, let's move on to the next Bill, which is. Thank you. Next Bill is HB 2209, requiring health insurance carriers to honor a patient's written assignment of benefits to a substance use disorder treatment provider. First up, we have the State of Hawaii insurance commissioner. You're not the insurance commissioner, but I'm sure you work closely with him.

Good morning Chair, Vice Chair, Members of the Committee. Justin Tu from the Insurance Division. You know the Department appreciates any efforts to increase access to substance use disorder. However, our comments are concerned with, you know, this creates a special class for substance use disorder professionals that are not granted to any other healthcare professional.

Primarily, the assignment of benefit prohibition is not afforded to any other healthcare professional. And our concern is that it would decrease or disincentivize a provider from signing or becoming a network provider with the insurance. Additionally, the term 'valid' as used in the statute for a valid assignment of benefit is not defined, and we're not sure what would be considered a valid assignment of benefits. Again, we mentioned that there's a private right of action with.

It creates a private right of action for the substance use disorder providers that's not afforded to any other provider and were concerned that the asurgent litigation would increase costs for insurers and then be displaced to premiums. And then finally, the term substance use disorder treatment provider includes a definition that some of the outpatient substance use disorder treatment centers are not subject to state licensure. And other states where we've seen that - it can lead to insurance fraud. So, for example, in California, Arizona, and Florida, they have cases of sober home fraud where, you know, these homes are unlicensed and they fraudulently bill Medicare and private insurance. Thank you.

Thank you. Let's see. We have HMSA.

Good morning, Chair, Vice Chair, Members of the Committee. I'm Moani Wright-Van Alst on behalf of HMSA. You have our written testimony, but I'd like to point out a few things. First, we strongly support efforts to expand access to substance use disorder treatment and agree that this is a critical area for our community.

However, as it's currently drafted, this will require health plans to make direct payment to non contracted providers. This raises serious concerns for both safety and long term affordability. Allowing non participating providers to receive direct payments creates incentives, quite frankly, for aggressive marketing and it increases the risk for fraud in the substance use disorder space.

Something that we've already actually seen happen locally and there are national trends as well. So unfortunately, this Bill could open the door for exactly the kind of measures that we're really really trying to prevent. So while we fully support the goal of overall improving access to care, we do have very strong concerns about this Bill and the way - the potential consequences that it could cause. I'm here for any questions. Thank you.

Thank you. The Ohana Addiction Treatment Center on Zoom.

Aloha Members, my name is Elliot Smith. I'm the CEO of the Ohana Addiction Treatment Center. I did submit written and I'm providing oral testimony. I'm also available for questions afterwards. So we strongly support this Bill. So even when a patient signs an assignment of benefits directing payment to the provider, insurance companies such as HMSA refuse and sends the reimbursement to the Member instead.

In repeated calls, HMSA representatives have told told us that they have a standing policy not to honor provider assignment of benefits for direct payments. What that means is $10,000 to $30,000 checks can hit people weeks after discharge creating serious relapse risk. It also blocks access because families must front tens of thousands.

And in these same cases, HMSA will not provide the provider the explanation of benefits or basic claims status details and tells us to obtain it from the Member. Patients become the payment middleman and providers lack visibility. On fraud, nothing in this Bill removes prior authorization, medical necessity review, audits, denials or recoupment. On network leverage,

I asked HMSA to state how many in network residential facilities they actually have in Hawaii and the real wait times. While low local rates are subsidized by the state and taxpayers, thousands of Hawaii families support this and at least 29 other states already require acceptance of assignment or direct payment. Hawaii should follow suit.

In terms of the valid assignment of benefits argument proposed by the DCCA, that's a very simple fix by creating a standardized form that could be posted on their website. These are not huge hurdles or challenges. This opens access to care in our state and access to families staying in Hawaii to get care and treatment. Thank you. And again, I'm available for questions.

Thank you very much. Let's see. For the record, we have a testimony from Mayor Alameda from the County of Hawaii in support. Hawaii Substance Abuse Coalition, Alan Johnson.

We stand on our testimony in support.

In support. Okay. And Brian Baker, Hina Mauka.

We also stand on our testimony.

In support. Thank you. Let's see, we have testimony from, in written form, from nine individuals, all of them in support. With that, anyone else wishing to testify on this measure? Members, any questions?

Well, hi. Can I testify?

I'm sorry, go ahead. Please identify yourself.

Yeah. Dr. Mike McGrath. I'm a psychiatrist and addiction doc practicing Hawaii for 30 years. I've been doing addiction medicine for about 20 years. I've had the benefit and the luck to be able to work in just about all levels of care for mental health and addiction in the state of Hawaii and now also in some other states via telehealth. And I do recognize that - I'm in full support of this Bill, number one -

But I do recognize that there can be issues in other states of fraud, but I have not seen that in Hawaii. In fact, you know, our biggest problem, as we all know, is the long wait times to get into residential treatment. And this procedure, although going to residential treatment can be expensive, it's life saving. It can be the thing that makes the difference for our folks that are pending a opioid overdose. And we know that there's an epidemic of that going on with the fentanyl. So anything we can do to incentivize and encourage providers to be here in Hawaii and open residential treatment centers, I would be fully in support of and I think this Bill does that. Thank you.

Thank you. Anyone more testimony? Oh, yes, Please proceed.

Hello. Thank you. Aloha. My name is Scott Schroeder. I provided a written testimony and I'm in full support of this Bill. I'm the owner and CEO of two other licensed and accredited treatment centers serving our most vulnerable community with mental health and substance use disorders. And just like Dr. McGrath said, we're providing life saving treatment. Yeah.

And there's no other, you know, there's 29 of those states that, that support this. But it prevents the Member from assigning benefits to the healthcare facility providing the services. And, and that's really a shame because as a CEO and an owner, I have an ethical dilemma accepting a Member and then setting them up for failure when they get home with a $20,000 check for coming to our treatment center. It's just a complete setup for a relapse and so I am in full support of this Bill. Thank you.

Thank you. Again, anyone else wishing to testify? If not, Members, questions? Let's start with Representative Amato, followed by Representative Hartsfield.

Thank you. Chair, question for HMSA please. Thank you for being here. How many providers in network does HMSA currently have and what is the average wait time?

I have to actually follow up. I took a note on that.

Okay, thank you. Thank you. Chair.

Please.

Thank you, Chair. I have a question for the insurance Division, DCCA. It's noted in the testimony in regards to subsection E that I guess there's an anticipation of a surge in litigation. And I'm curious as to what type of litigation DCCA is referring to.

That's a great question. So in subsection E of newly added sections, so for example, it appears on page three and on page six. All right. Subsection E states 'a substance use disorder treatment provider who is denied payment by a health insurance carrier's - who is denied payment by a health insurance carrier despite a valid assignment may bring a civil action to compel compliance and may be awarded injunctive relief, actual damages, interest, reasonable attorney's fees and costs.'

So pursuant to the statute, anytime a provider who is denied payment by valid assignment, again, we're not sure what constitutes a valid assignment. It says they can sue in court to compel compliance, so they can demand payment. Right. And on top of that they can get damages, interest and attorney's fees.

So a fee shifting statute which incentivizes attorneys to bring these type of suits and then costs the fees for the litigation. So these are the type of litigation that we expect. It's a private right of action that is created by the statute of subsection E.

So is it safe to conclude that it's anticipated there will be a number of denials?

I mean, I'm not sure if it's denials, but you know, it also doesn't say what a denied payment is. Right. So if insurance carrier is, you know, just trying to verify treatment, performing pre authorization or utilization review, assuming it's allowed, you know, is that considered denial under the statute? It's just the fact that the litigation we brought, you know, it allows for a claim that litigation to start and that is costly.

Thank you. So I have a follow up question with HMSA in regards to this matter. Hi, thank you for being here. I'm curious to know how many requests are denied by HMSA for.

I'm going to unfortunately have to take that back as well.

Yeah. If you could provide us that information. I think that would be helpful. Thank you so much.

Thank you, Representative Martin.

I had a question for HMSA. Sorry. So you folks are already paying these out after going through your due diligence, making sure that the client is actually referred and they are indeed going to attend this treatment program. So what's the difference for you guys of paying the client versus the facility? You've already done your due diligence, you already know the client is there.

Great question. So what this Bill really is addressing are those providers who are not actually contracted with HMSA, they are not in network. And so with non contracted providers we pay the patient directly and then they are to pay the provider. We want contracted providers because that helps overall quality. We have those assurances in place.

They have signed a legally binding agreement with HMSA to follow the quality measures. It helps, you know, reduce costs in the long term. There's many reasons that we would like to contract. This Bill is really talking about providers who are not contracted.

So when you say it reduces cost, is that because you pay the contract with the providers?

No, it's really just because we're able to max - like look across the board of how we're paying everybody. Right. And making sure that we're paying for necessary services would be one thing. Right. There's whether it's prior authorization or that these are clinically appropriate. And so there are rules of what we're going to pay for.

That's really what we're looking at. So, we would love all providers to contract, I think all insurers would love to have all the providers contract with us and that would ultimately solve, I think, what's trying to be proposed here.

Thank you. Members, any other questions? If not, I do have a question for Hina Mauka. Mr. Baker. Mr. Baker, you've heard the concerns expressed by the Insurance Commission office as well as HMSA about payments to contractors. I mean contracted provider, non contracted providers, unlike you, who you are a contracted. So what do you, what are your thoughts in terms of the issues of possible fraud and misuse?

So I do not see the fraud piece as exceptionally an issue here. My real concern is about what it does, putting a large sum of money into the hands of somebody who is brand new into their sobriety and the risk that it places on that client. As long as the services have already been authorized, I see that as the health plan taking their responsibility, just as Representative Martin had mentioned.

All right, thank you very much, Appreciate it. Let's move on to the next Bill, which is House Bill 1961, relating to prohibiting persons from interfering with another person's access to a health care facility. Department of Health, in offering comments. Planned Parenthood Hawaii, Jen Wilbur on Zoom.

Hello, Chairs and Members of the Committee, my name is Rachel Kinsey. I'm a policy manager at Planned Parenthood. Alliance Advocates stepping in for Jen Wilbur, who was unable to make it the hearing today. PPAA is here in strong support of HB 1961, a Bill that will prevent protesters and harassers from disrupting access to health facilities.

And we are so grateful that the Committee scheduled this Bill so quickly. We stand on our written testimony and are available to answer any questions. Thank you.

While you're on, may I ask you, you do propose an amendment. Could you explain what the proposal is?

Yes. So the original Bill includes a provision preventing noise disruption and trespass, but there are already statutes addressing those issues, so we are just recommending removing those two provisions from the Bill. I believe it's subsection two and three to ensure that there's clarity and not duplication in the Hawaii statute.

Okay, thank you very much. Also on Zoom, I believe we have the Hawaii State LGBTQ plus Commission. Not present. We have testimony from AAUW as well as HOKU PAC in support. Hawaii Nurses Association in support. Healthcare Association of Hawaii in support. Let's see. Dars Matsunaga, Indivisible Hawaii Healthcare Team on Zoom.

There's been a switch on speakers. Dars couldn't make it from the Big island, but thank you, Chairs, Co Chairs and Members for this opportunity to testify in strong support of HB 1961. My name is Anne Leake. I'm a retired nurse practitioner and I've been practicing in federally funded community health centers across Hawaii for over 30 years.

Protesters continue to harass patients and providers at Planned Parenthood Health Centers, especially in Honolulu. Protesters lean on patients and providers cars, yell slurs, and stand in front of patient vehicles to prevent safe access entering and exiting clinic. Given the extreme and growing polarization of our times, we cannot assume this kind of behavior will remain limited to Planned Parenthood. Hawaii needs to provide the police more tools to intervene in situations like this.

We strongly support the Bill included in the Women's Legislative Caucus package that will make it unlawful for a person to interfere with access to a health care facility facility, including prohibiting physical obstruction, disturbing the peace, trespassing, telephoning a clinic repeatedly, or threatening administrative staff, providers and patients.

Fundamentally, patients and providers should not be afraid of being harassed or accessing legal health care services. We strongly support this Bill from the members of Invisible Hawaii's health care team of which I am a member and I think our team would also support the amendments that the planned parent speaker just mentioned.

Thank you very much. On zoom Pride At Work Hawaii.

Good morning. Michael Golojuch Jr., he/him pronouns, President of Pride at Work Hawaii. We stand in strong support of this measure. We are grateful for the carve out to ensure that labor unions will have their right to strike in this position. But it is a sad day here in Hawaii when we need a Bill like this. When patients are being harassed trying to get health care. That is not the Hawaii I grew up in and that is not the Hawaii I want to leave to the next generation. So we definitely know that this Bill is needed.

We encourage you to pass it. We support the amendments made by Planned Parenthood and health care is a human right and accessing health care free from obstruction and from obscenities and being harassed and belittled is not an acceptable practice here. And so we encourage you to pass this Bill. Mahalo.

Thank you very much. We have testimony, written testimony in support from the American College of Obstetricians and Gynecologists Hawaii section as well as the Hawaii Primary Care Association and the Hawaii State Democratic Women's Caucus. And I might note we have written statements from more than 50 other individuals, all of them in support. With that, have I missed anyone wishing to testify on HB 1961, please step forward.

Aloha. Thank you Chairs and thank you Members. My name is Jonathan Leibowitz. I'm the Director of Field Services with the Hawaii Nurses Association. We wanted to draw special attention to the labor carve out of this Bill. We do have some concerns that the carve out isn't broad enough to ensure that not just during labor - during a labor dispute that community Members who who feel the need to stand up in support of nurses and other healthcare members in a labor dispute will also be protected under this language.

We believe this language should cover them. But we want to make sure that it is exceedingly clear because when employees at hospitals are driven to the point where a strike is the only option. Looking at the hospitals in Hawaii we're looking at really the largest employers, some of the most powerful private sector employers in the state and any anything that makes, that tips the scale against workers and against community members who want to stand with the workers for better health care and better care does does bring us concern.

Although we don't have any concern with the overall goal of the Bill, the method in which it gets there does raise concerns for the rights of union members and of community members exercising their right of free speech around a labor dispute. So thank you very much.

Just for the record, the proposal states in subsection B on page 4, this section shall not apply to actions taken as part of a labor demonstration or when exercising the right to strike. Anyway, anyone else wishing to testify on House Bill 1961. If not, Members, questions? Representative Garcia.

Thank you for being here. In your testimony, you mentioned certain protesters and harassers at Planned Parenthood facilities here in Honolulu. I'm just curious, how many police reports have been filed for harassment or violent attacks or verbal assaults, perhaps from these pro life protesters?

Sorry, I don't know the answer to that question, but I will seek it out.

Okay, well, how about for Planned Parenthood, then?

Planned Parenthood on Zoom. Would you like to respond to the question?

I don't have the number of police reports, but what I can tell you is that between 2023 and 2024 nationwide, there's been over 3,582 instances of harassment, 621 instances of trespassing, 269 death threats and 12 bomb threats on abortion health centers. Violence against these health centers is extremely common. And we are in constant communication with Honolulu Police Department who is supportive of making sure that patients are safe.

All right, well, I'm just curious. I'm not asking about nationally, but locally, here in Honolulu, how many police calls were made from Planned Parenthood for violent attacks or verbal assaults or harassments from pro life advocates who were exercising their First Amendment liberties on the sidewalk on Beretania Street?

As I said, I don't have the number of the exact calls down, but I can follow up after the hearing.

Okay, please do. Thank you. Thank you, Chair.

Thank you. Members, any other questions? If not, let's move on to the next Bill, which is House Bill 2343, repealing the specific deadline for the Hawaii—the Maui State Veterans Home to be assimilated into a state agency. Let's see, we have Department of Defense, Major General Stephen Logan. Oh, General.

Different General. Chairs and honorable members of the Committee, Brigadier General retired, Neil Witseoshi, obviously not General Logan. I'm standing here for the Adjutant General. Chair, we really appreciate you hearing this Bill. The Department stands on its written testimony in support and is available for any questions you may have.

Okay, thank you. On Zoom, I believe we have Sean Sonata, HHSC, Oahu Region.

Good morning, Chairs, Vice Chairs, Committee Members. We just—Oahu region submitted comments. I'll be available for any questions.

Okay. Thomas Driscoll.

Chairs, Vice chairs, Members, I'm Tommy Driscoll, retired Colonel, US Army Medical Service Corps, testifying as an individual in strong support of this Bill. I stand on my testimony. Available for questions. Thank you.

We have written testimony from the Hawaii Office of Veteran Services, as well as the Maui Veteran Services Offices. Anyone I missed who wishes to testify on this Bill? Members, any questions?

Yes, quick question.

Yes, Representative Amato.

Question for Colonel Driscoll, please. Thank you for being here today. So, I want to make sure if we make this switch, you know, I was one of those original people that was like, hey, you know, Maui should really be controlling Maui.

Is the Hawaii Health Systems Corp, HHSC, prepared to continue to care for this facility until such time as is practical that Maui gets its act together and actually forms its group again?

Yes, ma'am, I can answer. Absolutely. We've had extensive conversation with the CEO who's also online here on this point. Building on their great work at...

They are willing to support this initiative on behalf of the veterans, are absolutely capable of doing so for a period of time until such realignment might take place with Maui leadership.

Excellent. Thank you so much. Thank you, Chair.

Would you like to address that question as well, to the representative of HHSC who's on Zoom?

I'm satisfied with Colonel Driscoll.

Thank you. Any other questions, Members? If not, let's move on to the next Bill which is Bill 2160, relating to the Hawaii Cancer Research Special Fund. And first up, we have Tax Foundation of Hawaii, Tom Yamachika on Zoom—not present but offering comments.

We have Hawaii Medical Association, support. American Cancer Society, Cynthia Au, in support. We have written testimony from let's say about a dozen other individuals in support. Anyone else? Well, anyone I missed who wishes testifying this—oh, I'm sorry, I see Cynthia Au there. You want—okay, please step on.

Dear Chair and Vice Chair and member of the committee, thank you for the opportunity to speak. My name is Naoto Ueno. I'm actually testifying today as a private citizen in my personal capacity and not on behalf of University of Hawaii or University of Hawaii Cancer Center. I want to talk about that 40 to 50% of this room will have cancer, will have experienced cancer.

And I have two cancer in my past and I'm a two time cancer survivor and I was diagnosed with one taucoma on my left thigh and the other one is pre-leukemia, basically leukemia. I had a transplant eight years ago.

So, the funny part is that at my previous—where I used to work—I worked on the developmental research-driven cancer treatment. Years later, I ended up receiving the same treatment I developed, and I am here and alive.

So, what I'd like to say is that scientific advancement really is an important component that makes a difference in the outcome of cancer—basically, cancer patient outcome, but also prevention of the cancer. So, there's a lot of things I learned from the process and I think it's important to really understand what cancer research is about.

And this is my reading, my perspective, as a survivor, as a citizen, and then also in this entire group that we—it's important to address this. And I came here because I simply wanted to share why it's important, why this is important, and why I feel grateful for all the members about discussing this topic.

So, mahalo for your time and for your service to our community. Thank you.

Thank you. Thank you very much, Doctor. Please step forward. Would you like to testify?

My name is Linda Asato. I submitted written testimony.

Yes, we have it.

Thank you. But I would like to add the reason that I'm here personally, I'm a three-time cancer survivor. The first time I was detected or diagnosed with cancer was 1993. My mother had been also a breast cancer patient.

And when I looked up her records at Straub, I found that the four drugs, the chemotherapy that she had received, were the drugs that were used on me 20 years later. So, I was saying to myself, you mean in 20 years, there's been no improvement to the standard of care? So, I decided that I would participate in a clinical trial.

So, the drug that I was given was Everlimus, and today, that drug is used for treatment of cancer patients. As a patient advocate now, I would like to see the research continue and with the restrictions on the funding from the cigarette tax, it really ties the hands of the Cancer Center.

So, I am begging you to take those restrictions off, please, for the benefit not just of myself, but I have family and friends who are also affected. So, thank you for listening to me. If there are any questions, I'd be happy to answer.

Thank you. Thank you. We're all glad you're here today.

Thank you. Thank you so much. I'm a 30 year survivor.

Members, any other, any questions? If not, let's move on to the next Bill, which is House Bill 2505 relating to assisted community treatment. State Department of Health.

Good morning, Chair, Vice Chairs, and Members of the committees. Chad Koyanagi, Department of Health offering support of this measure. We submitted timely testimony yesterday. All of these—we forgot to offer one phrase in the as an amendment which I'd like to mention now is in Section 2 and it refers to the certificate being filed by the Director of Health.

We forgot to offer amendment that should be submitted by the Director of Health or the community outpatient behavioral health provider. Here for comments, questions.

Okay, thank you. Let's see. We have the Judiciary Senior Judge, Dien Medeiros, offering comments. IHS, Institute for Human Services, Angie Knight.

Chair, Vice Chair, some Members of the Committee. IHS stands on its written testimony, but we do want to offer comments to the proposed amendments of changing the five-day statistics. Currently, there is a gap as HSH with the deferral for the diversion of Act 26 is disincentivized to hold clients.

And so, what we're asking is that the AMHD, DHS, and the local law enforcement collaborate on preparing packets that can be used for petitions of ACT, as Act 26 usage is evidence for court mandated treatment.

And currently, we have some individuals who have had over 30 citations and that is used as evidence in the packet to get the court mandated treatment. And so, this will help address the current gap. Otherwise, it kind of continues as is and I'm available for questions.

Okay. Just so I understand before you step down, the Bill says that these petitions have to be heard within five days?

Yes.

Others have suggested that that's unreasonable time. But you're saying you should support five days?

We're saying that we understand the restraints of the five days. So, we are in support of the 10 days so we can have the proper hearing. However, to assist the GALs in the preparation if the stakeholders already involved with the client or the one eligible for the petition can help prepare said packet for the GAL.

Okay, thank you.

So, they don't have to do so much in those 10 days. Thank you.

Let's see. We have Mike Goodman offering comments and that's it, I guess. Anyone else I missed who wishes to testify on House Bill 2505? Seeing none. Members, any questions? Seeing none. Department of Health, can I ask you to step forward again? And you made reference to a suggested amendment that's not in your testimony.

Could you explain again what's—what your proposal amendment would be?

So, the current language states that petition will be filed by the Director of Health. I'd like to also add it should be filed by the Director of Health or the community mental health outpatient provider, any instances where the outpatient provider would be in a better position to file the petition and would be the organization that would follow the patient in the community to maintain their progress and monitor the ACT.

Okay, thank you. Now I understand. Thank you for making it clear. Members, any other questions? If not, let's move on to HB 1537, relating to mental health services for adolescents. First up, we have Hawaii State Department of Health in support. Are they on zoom?

Good morning.

Oh, I'm sorry. Go ahead. Yes.

Good morning, Chair, Vice Chair, and Committee Members. My name is Kayleigh Okwaro. I'm the Administrator of Adolescent Mental Health Division, here on behalf of the Department of Health. We stand on our written testimony in strong support of this measure which would appropriate funds to provide community-based programming for adolescents.

And I would just highlight a couple of things from our written testimony. The first is that we are working very closely with the other state child serving agencies. And if this measure passes, we'll ensure that we're providing programming that is coordinated across these agencies.

And we also offer suggested amendment to push the reporting date to the Legislature out a year so that we have enough time to collect data about the utilization and effectiveness of the programming. I'm available if there are any questions. Thank you so much for the opportunity.

Okay, thank you very much. Office of the Public Defender, in support. See, we have testimony from the State Procurement Office, as well as the Hawaii Substance Abuse Coalition offering comments. Hawaii State LGBTQ Commission on zoom.

Michael Golouch. Okay? Mr. Golojuch, I believe you're, you're muted. Sorry, let's, let's move on, and we seem to have a—oh, okay. Yes. Please step forward. Mr. Johnson.

Aloha, Chair, Vice Chair, distinguished members. I'm Alan Johnson, the Hawaii Substance Abuse Coalition. As you know, in all the testimonies, the people's rates of anxiety, depression, and trauma are just astronomically high here in Hawaii. They're just out of sight. And we see firsthand that it also really involves substance abuse, all across our state here.

From the perspective of providers on the ground for substance abuse, we see that mental health and substance abuse are inseparable. Many youth who struggle with untreated mental health are coping with using substance abuse, alcohol, and tobacco. And prevention cannot succeed in silos where we only treat one thing.

Right now, there is no mental health prevention program in the state. There has been a substance abuse prevention program for many, many years. And substance abuse now has also been treating mental health. And so, in the treatment world, we have expertise. We're working with PAMB.

We're proposing that this particular bill be go to ADAD to help ADAD to evolve to combine mental health and substance abuse together. PAMB was really great for those most severe. We're looking at kids who are in schools who have problems.

And so, we're ready to combine them because we have the expertise and if science is there promoting that this now happened that mental health and substance abuse come together and stop treating them separately. And so, we're in the schools. We already got trusted relationships with the schools and the counselors and principals. We've got evidence-based program.

We're culturally responsive already. We already know how to deal with kids who are in crisis. We have already all the staff there. We have expertise in mental health as well as substance abuse. We just don't use it in schools because we can only use substance abuse. So, these silos have become a problem for us.

We think it's time for us to evolve in the Federal Government's putting out grants and pushing for all of us that substance abuse evolved into mental health, not the most severe like with...and but that the ADAD shift to handling all those kids who are not really most severe but got serious problems at the beginning stage.

So, we're ready; we're comprehensive. We look forward to working with it. We think there's a tremendous opportunity to make a big difference in all our problems.

Thank you. Mr. Johnson, you used the acronym ADAD. You want to explain?

The Alcohol and Drug Abuse Division.

Thank you. Let's see. We have testimony from—okay, for the record, we have written comments in support from Catholic Charities of Hawaii, Hawaii Medical Association, and Hawaii Children's Action Network Speaks. I understand back on Zoom, we have Michael Golojuch. Please proceed.

Good morning. Michael Golojuch Jr., he/him pronouns. I am representing—I'm the Vice Chair of the Hawaii State LGBTQ-plus Commission. On behalf of the Commission, we want to thank you for hearing this Bill. It is desperately needed to make sure we have—our keiki have access to mental health.

We do, in our—you have in our written testimony that we do would like to see an amendment or at least in the Committee report calling upon if this pilot project goes through, to make sure that they explicitly address the needs of our mahu LGBTQIA-plus and gender non-conforming keiki.

This is very desperately needed, especially since the Federal Government has declared war on the transgender, gender non-conforming, and mahu community. The Lemkin Institute, which overseas—which watches out for genocide across the world, issued a warning earlier last month that the United States is in the beginning motions of a genocide for our transgender community.

And this is being felt all the way to everyone within the gender non-conforming, transgender mahu community. And so, we need to make sure that keiki know that they are loved, that they are taken care of, and that the state will stand and protect them.

And this is one of the ways you can do that by ensuring that this—that when this pilot project starts off that it's written into its DNA that the needs of our queer kids are taken care of. So, we encourage you to pass this Bill.

We ask for amendment or something in the Committee report making sure that this happens. We do want to go let you know that the Senate added it to their Committee Report when they heard the companion bill a couple days ago. So, we, again, thank you for hearing this Bill. We look forward to it passing.

Thank you. Anyone else wishing to testify on HB 1562? Seeing none. Members, any questions? Representative Takenouchi. Oh, I'm sorry. We have one more testifier on Zoom. Please tell us who you are.

Aloha. I'm Kayla Munoz and I am a social work student at UH Manoa and I'm in support of this Bill. This Bill is important because it, it addresses the lack of mental health awareness and programs that involve youth. Youth in Hawaii have gone through events such as the pandemic, Maui fires, and school gun threats.

Adolescents also have to deal with personal traumas. They also suffer from the dangers of social media and the political and economic whole state of the world. With the mixture of these events, a lot of adolescents develop anxiety, depression, drug abuse, and suicidal tendencies.

I myself have struggled with mental health in my youth because of the effects of the pandemic and also personal family issues. I had suffered from abuse as a child, but it was not taken seriously when I had brought it to a school counselor.

After that, I was discouraged from seeking help and taking mental health seriously and it wasn't until I was an adult that I had the resources and autonomy to get the help that I needed. These services must be created so that adolescents do not fall through the cracks of society. Mental health severely affects the overall wellbeing.

We must take preventative care for our keiki and take mental health seriously. Thank you for your time and consideration.

Thank you. Thank you, Kayla. Let's see. Anyone else wishing to testify on this Bill, please step forward. Mr. Black.

Aloha, Chair Takayama, Vice Chair, and Members of the Committee. My name is Brian Baker, and I am President and CEO of Kena Mauka, an organization providing mental health and substance use disorder treatment and prevention.

I'm here today in strong support of HB 1537 because this Bill reflects our shared responsibility to protect the mental and emotional well being of Hawaii's young people before they reach the point of crisis. Hawaii already has a substance use prevention program in place. We have the workforce, we have the school partnerships, and the community connections.

What we're missing is a coordinated approach to mental health prevention. Even though we know mental health challenges and substance use often begin together, adolescence is a critical window of development when young people experience intense emotional change, social pressure, and brain development. This is also when anxiety, depression, and other mental health challenges also begin to appear.

When those needs go unrecognized, young people still seek out a way to cope. Many of them turn to alcohol, vaping, or other substances, not out of defiance, but to calm anxiety or escape emotional pain. The data is clear. Youth frequently use substances as a form of self-medication, just as adults do.

That reality tells us that mental health prevention and substance use prevention cannot be separated. HB 1537 allows us to integrate mental health prevention into existing trusted systems, teaching coping skills, emotional regulation, resilience, and help seeking behaviors before harm takes hold. When prevention is done well, the return is significant.

Stronger school engagement, reduced substance use and violence, healthier families, and lower long term health care social costs. Most importantly, it gives youth—it gives young people hope and the skills to navigate life's changes. HB 1537 is a practical, evidence-based investment in Hawaii's future. And Kena Mauka respectfully urges your support.

Thank you, Mr. Baker. I'm sorry. By the way, did you submit written testimony on this? I didn't see this. Okay, thank you. Anyone else wishing to testify on this? Seeing none. Members, questions?

Question.

People were talking about...

They're related.

I know, but so, that one already passed.

Yeah.

Okay. I have a question for ADAD. County. Can it be online?

Yeah, yeah, I'll try my best.

Okay. Yeah, no, I just, there, there's, there was a lot of testimony in these bills talking about the benefit of combining more general mental health issues, these lower level ones that would be addressed these programs, like anxiety, depression, these kinds of things, with substance abuse infrastructure.

How could, if we did want to take advantage of those relationships, that infrastructure that already exists in our schools and community organizations, how would that be written into this Bill, do you think?

I would have to logic further to see more specifically. I do believe through some of the work groups and committees that they've mentioned that we have representatives from Health Administration participating and in BHA, we all work together.

So, whether it's in ADAD or CAMD, I feel that we can ensure that the intent, we can work towards that intent and lead into action, whatever.

So, is it though CAMD, ADAT, or obviously, they are siloed within the Department of Health, so we'll have to reference a specific.

I know we're talking about the digital platform now, but people were testifying on the previous Bill during this time, which is why it brought up questions in my mind, really, on the previous Bill, which is about youth mental health contracts to service providers.

Could I offer something to this point? Thank you so much. And thank you, Dr. Matsu. Yeah. If I could actually expand on it, so, within the Department of Health, there are so many divisions that intersect with child and adolescent mental health. Obviously, the Child and Adolescent Mental Health Division is one. The Alcohol and Drug Abuse Division is another.

Our Injury Prevention Branch is actually the seat of our suicide prevention activities. Our Family Health Services Division actually does quite a bit of community programming and outreach and preventive programming.

So, I think really what's critical, regardless of which division within the Department of Health is the lead on this particular measure, is that we are increasingly trying to identify where those services become fragmented, where we can strengthen the connections between the work that all of us are doing so that it is more seamless for kids and families and how we can kind of work together when there are measures like this to create programming that ticks a lot of boxes.

Right? So that—because each of us has a very, it's true, specific perspective and mission, thing that we're trying to accomplish. But in truth, there are so many intersections, and we've been having a lot of discussion recently about how to fortify some of those intersection points so that we're all on the same page. We're all working together.

We know about the supports and services that each other is providing and we can make some of those connections for kids and families.

And you know, to some of the earlier testimony from Mr. Johnson and Mr. Baker, there is expertise in other places of the Department of Health that we can draw on to build some of the programming and to build the scope for, you know, ultimately, the request for proposal that would go out for these services.

So, I do feel confident that we can pull all of these critical partners together and make sure that the programming that we provide really addresses a lot of these areas, which are completely interrelated.

Thank you.

Okay, thank you. Any other questions? Yes. Representative Takenouchi.

A quick question for CAMD. Thanks for being here. Seeing that this Bill came from the Keiki Caucus, thank you to the House Chair and introducer for this to focus on mental health. Were you guys involved in the drafting of this Bill at all—the Department?

For HB 1537 or for...?

No, for this, for the mental health app platform. The digital platform, 1562.

Yes. Yes. We weren't involved in the drafting of this Bill.

Okay. Would you guys, would you be going to quickly highlight, I guess what the intent—or I was left here that you were going to be coordinating with other departments working on this.

Could you just quickly highlight the intent of this app and how it's maybe covering some of the gaps outside of what the Department of Education is doing with their mental health app platforms?

I know they have a couple like, is it, you know, cover just, I would assume, you know, people outside the DOE, but also, are there identified gaps in the platforms also already being provided that you guys are hoping to also cover, like different, I guess, topics or areas?

Yes, thank you for bringing that up. I have been in discussion with school-based behavioral health leadership about their platform. I think that there are some places where this digital mental health platform could expand on the work that they're doing within the DOE. For starts, I think it would be more broadly available.

So, not just for children in public schools or not just for folks who have access to their platform.

The digital mental health platform, because it comes more from a public health perspective, I believe that it offers more anonymity and would be able to—at least the intent of it is that it would be able to highlight county specific resources so that if a young person goes on this platform, not only could they get some psychoeducation and some information about how to manage their own mental health and coping strategies, etc., but they would also be able to see what's available in their community for support and learn about some of those specific types of things.

So, I do believe that what's being proposed in House Bill 1562 is broader and has a more of a public health impact. And so, it's a little broader in scope, a little more anonymous.

And I do think that the engagement with the DOE platform has not been what they've wanted it to be, and I don't know what the limitations have been there.

I'm still learning about the platform that they have, but we are working very closely together and trying to make sure that anything we do is added value and not redundant.

Sorry, one quick follow up. Quick follow up to that. So, is the intention, if this pilot is successful, is the long term goal for you guys to absorb all that work that you—because maybe you're better equipped to set up that kind of program?

You know, we haven't specifically talked about taking over what they've done, but certainly, we want, we would want to make sure that it's very clear where young people could go for help and we wouldn't want kids to be confused about which platform they're supposed to be using.

But we haven't had conversations about sort of one subsuming the other yet. I think if, if passed, then we'll have a lot of discussions about rubber meets the road, how would this look and how could we make sure that there aren't any redundancies and that there's a, there's clear access for any young person who wants it.

Thank you. Appreciate the collaboration.

Thank you so much for the question.

Okay, thank you. Any other questions? If not, let's move on to the next bill, which is House Bill 1731 relating to Osterholmes. And first up, we have the Hawaii State Department of Health.

Chair marking. My name is Dr. Ryan Lee, Medical Director of the Developmental Disabilities Division. I'm also the Acting Administrator for Developmental Disabilities Division, Department of Health. We submitted our written testimony and it offered comments and we do stand on that testimony. This is an issue of residential capacity, specifically 1915 C waiver, which we operate and administer.

And, and it's not additional resident residential capacity for those bishops in the neighbor islands that we at the Department are undergoing partnership with DHS division to support expansion of the capacity in the neighbor islands through a waiver renewal.

So we're right in the middle of the public comment period on the waiver renewal that offers incentives to open new residential homes, foster homes on neighbor islands. We believe that this may address that issue. Additionally, we have a few new services that may reduce transition outside of the 1915 C and to 1115.

In order for individuals in the 1915 C to be able to reside in a CCFFH, a waiver amendment would be required and that would require approval through Cms. This is a complex issue. We agree with the intent of it.

However, we would like to discuss this issue collaboratively with the stakeholders such as dhs, DD Council, the advocates, OCA and the CCFFH agency caregiver providers. We just would like to clarify all the regulatory requirements and what the community needs truly are and what impact this might have on other populations that may be attempting to access the ccffhs.

We'd like to do this because we don't want to be in risk of violation of any federal rules and regulations in our waiver and also not to displace any medically free El Caputo. Thank you.

Department of Human Services on Zoom.

Hi. Yes, thank you. Good morning. My name is Ranjani Star. I'm the interim Deputy Director of Med Quest Division and I represent the Department of Human Services on this bill. Today. The Department stands on its testimony, but we want to reiterate that we are strongly in support of a collaborative approach.

Approach that includes the voices of the DD Council, the Department of Health, the Legislature, various stakeholders, including all of the families represented in this population, as well as, of course, the dhs. So we are really looking forward to being able to move forward in a collaborative way. I'm happy to answer any questions you might have for us.

Okay, thank you. Hawaii State Council on Developmental Disabilities.

Good morning. Chair, Vice Chair, Committee Members. My name is Daintry Bartoldus. I'm the Executive Administrator of the Hawaii State Council on Developmental Disabilities. First off, I'd like to recognize your Seattle Seahawk colors on your clock. Very lovely. Thank you.

Under the Hawaii Revised Statute, Chapter 333E, the council is responsible for guiding and monitoring Hawaiian Hawaii system of services for people with developmental disabilities. When system structures create barriers to community living or when the state is duplicating efforts across systems, it is our role to point this out and bring it. Forward for a solution.

Today, individuals with developmental disabilities are being told they cannot live in the community, care, foster family homes, not because of Health and safety needs, but because of which Medicaid waiver they are enrolled in. These homes are already authorized to serve individuals in an intermediate level of care, which includes intermittent nursing tasks such as medication Administration.

This is not a clinical issue. It is a systems issue. We are also placing unnecessary strain on a shrinking caregiver workforce operating in silos. When one program pays different, pays differently than another, similar, it pits each other against each other. Right. We have heard concerns about lengthy federal approval processes getting approved by Cms.

Yet we are doing something very similar in our arches today. We should be looking at how to align what is already working rather than assuming it cannot be done. I get it. For state employees and state workers, we are afraid of liability and we're going to say, no, no, no, can't do that.

Got to get approval from Cms. But do we? Do we really? Where's that law? Where is that? Perhaps a compromise can be a pilot on Oahu. Let's look at the DD adult foster homes. Here we have over 200.

If we look at them and convert some of those to community care foster homes, that could open up some more beds. Also, Department of Health DD division has hundreds of people on a wait list wanting to open up a DD foster home. How would we do community care? Not for everybody, but just as an option.

Sorry, I'll stop there. My time's up. But thank you very much for this opportunity to provide testimony.

Thank you very much. Let's see. We have testimony and support from the Disability and Communication Access Board on Zoom Hawaii Disability Rights Center. Louis Erteschik.

Yes. Good morning. Thank you. Chair Taki. I'm Louis Erteschik, the Director of Disability Rights Center. Everything that everybody said today is sort of true, but the bill is actually pretty simple. There's lots of care homes. It's a very complex maze of regulations. There's different types of homes, they serve different people, they're governed by in different departments.

But all this Bill does, and all we're really looking for is what we don't want is a categorical exclusion from the community care foster homes simply because you're in the DD waiver. And that's what happens right now. That doesn't really make any sense. And I know Danger and I worked on a couple of cases.

The problem was more on the neighbor islands. On Oahu, there's a fair amount of adult foster homes, DD homes. But on the neighbor islands, we had cases where I think maybe one of them was on Maui where it had a close after the fire and they could not find another DD home.

But there were some community care foster homes that would have taken the person, but because of the current regulatory structure, they weren't allowed to go into those homes. And so instead of going to a home potentially up the street or certainly on the same island, they were forced to fly to Oahu because.

Because the home on your island was somehow in a different, you know, in a different pile over here of regulation. So all we're saying is that it doesn't make sense to categorically exclude the DD and the ID population from these homes. I don't think they're going to be overrunning these homes. I saw that concern in the testimony.

I don't really see it because most of them are probably not geared to the DD population. It's more of a medical model.

But in the situations where it's appropriate on a case by case situation, it makes perfect sense and it can solve a real problem for a real person so they don't have to be uprooted from their community. So we really support the Bill and I thank you very much.

Thank you. See, we have written testimony and support from the ARC of Maui County, Responsible Care, Responsive Caregivers of Hawaii and the Hawaii Self Advocacy Advisory Council. Anyone else wishing to. All of them in support. Anyone else wishing to testify In House Bill 1731, if not Members. Any questions?

Hello, this is Linda Elento. I'm on Zoom.

Yes, please go ahead to hear me.

Or, or see me. I was trying to read my testimony while I just. I'm a parent and I'm. I am now very experienced in the. Just the needs of my, my son in particular. He's 25, having gone through both waiver programs.

Now, I was just surprised how the Department of Health and Department of Human Services actually kind of worked separately. And one doesn't necessarily know what the other one is. And the problem with that is parents like me aren't familiar with that. We know what our loved one needs.

We have no idea what's out there and how to find it. And I've agreed with all the testimonies that you've heard and I believe I've probably called or met everyone who has testified or their previous. I know there's acting administrators now. I've met with the previous ones.

But let me just read briefly just so I can stay on track here. Having had negative or recent negative and positive experiences with the waiver programs, I believe our state plan for the waiver programs are driven by both the Department of Health and the Department of Human Services. And further confused by the Medicaid health care plans.

All inflexibilities need to be identified and addressed. I believe a legislative audit is necessary, not a list of prescribed laws. And as you can see, there's a lot of parties involved. And I feel like we're all doing our own investigative trials here and trying to find out how to make this work. And as far as the.

I just wanted to bring up the Medicaid health care plan. As soon as they noticed that my son had, quote, long term services through the waiver program, they stopped helping me with all of his coordination with his health care plans. And that was detrimental when it was time to be in a skilled nursing facility.

So I appreciate the testimony. And again, some type of an audit, a group with power here that can bring people together and make something happen. But starting with the Department of Health, being able to talk to the Department of Human Services. Thank you so much.

Thank you. Let's see again, anyone else wishing to testify on this bill, if not Members. Questions?

Yes. Thank you. Chair for Department of Health, please. Thank you so much.

I have a lot going on in my mind. I'm a parent. That's why. Of a child with a disability. So let me just ask it this way. When it comes to these group home facilities, how many new ones have been opened that cater to disabled individuals on the neighborhoods?

Not many who are struggling with that.

I'm good. And here's why. There's Kako, Mako and Oko. And I think what this bill does is create Kako where we're all working together and noting the challenges on the neighbor islands. This bill provides a pathway to expand that until such time we can get more facilities available for the neighbor islands.

And so I appreciate your comments, but we're struggling on the neighbor islands to provide this type of facilities. In an already stretched community. And if we could start working towards getting. Getting these types of facilities towards our neighbor islands, we might not need this pathway.

But for right now, I think this is a way for everybody to put their heads together in a Ka Co situation. So we're all working together, DHS, DOH, and our disability community. So if I could encourage seeking opportunities to look for housing facilities to help expand options for our disabled community on the neighbor islands.

We're actively doing that.

Great.

Thank you. Our waiver renewal is doing that.

Thanks.

Representative Marten.

Yeah, so we heard from Daintry that there's people wanting to open foster homes specifically for dd and I saw in the written testimony that it said that the new services start July 1st this year if approved. So are there homes in the pipeline that are just waiting to be opened?

We're in the public comment period right now for this new waiver initiative. And so if it does get approved. Then we will hear from those homes. That want to take this on in the neighbor islands. And so we're hopeful that once July 1st hits that we're going to get people that take the supplemental payment incentives.

That we're ready to offer for that.

And so that would be existing homes or would that get some of these new.

These are new homes. They have to be newly established. So provide new residential capacity, not the existing homes.

So how long does that process take? I'm sure there's inspections. There's some sort of.

There is. It varies, you know, depending on the. Status of the homes and the plans within the home, whether they meet criteria. It may take a few months. Yeah, I'm not sure. You know, it depends on the home.

Thank you. Thank you. Thank you. Any other questions from Members? If not, thank you. All that great discussion. Thank you. Let's move on. To hospital 1853, proposing a network of dementia care specialists and support systems. First up, Executive Office on Aging on zoom.

Good morning. Chair Takayama, thank you so much for hearing this bill. The Executive Office on Aging would like to add comments to this bill. We appreciate the intent of this bill as it would provide. It would provide what's needed for those with dementia, their caregivers being able to navigate.

What we'd like to highlight, though, is at this time we have a Hawaii Dementia initiative, which has over 150 Members that support and help to create. We have a 2035 plan that's going to be that we're following.

And each year the initiative gets together to decide on what goals and objectives are going to work on for the year. And we're currently at capacity. We think this is a great idea.

We just think with the current economic climate of the state and the capacity issues at the Executive Office on Aging that it's just a little too early to launch this at this time. And we don't want it to replace or reduce any priorities in the governor's budget. And I'm available for questions. Thank you.

And I'm sorry I'm not there in person. Today's our board day. Thank you.

Okay, thank you very much. I guess your workload is a reflection of our trust in you. Let's see. Alzheimer's association of Hawaii, Kobe Chock.

Aloha. Chair Takayama and Chair Martin, Members of the Committee, Kobe Chock. With the Alzheimer's Association in strong support of this measure. We all know that Alzheimer's is a growing issue in this state.

And clinical care, especially on the neighbor islands, is stretched very thin from primary care all the way through specialty care, with many people unable to access basic services and needs. And this is especially true for people living with Alzheimer's and dementia. When you have Alzheimer's and dementia, things become a little bit more challenging.

And the fact that you need to fly to Oahu to even get an accurate diagnosis is somewhat unacceptable. We have new treatments that help slow down the progression of the disease and help maintain good cognition. And we can't ignore these developments. The state already spends hundreds of millions of dollars in Medicaid specifically for people with Alzheimer's.

In 2020, the number was at about $340 million per year in Medicaid spend on people living with Alzheimer's. In 2025, we're at about 412 million per year. So we saw about $60 million increase per year in Medicaid spending because we're not addressing this with the treatments, we can keep people at home for as long as they can.

We can get them on treatment, slow down the progression and ultimately save the state money.

I know there is a concern about capacity, but this bill specifically adds some positions to the Executive Office on Aging to build capacity and make sure we can do this for all of the neighbor islands and all the constituents who these are better. Thank you.

Thank you. See, we have AARP of Hawaii in Support, Hawaii Disability Rights center in support. Let's see. Hawaii Alliance for Retired Americans in support. Let's see. Jerry Perrone.

Good morning, Terry. Good morning. My voice today. But I'm a Member of the Alzheimer's Association. I'm an ambassador with them right now for the last several years. I'm also a Member of the Honolulu Medical Honolulu Emergency Management Reserve Corps, and I'm a Member of the Hawaii Medical Reserve Corps.

And that combined with the fact that I've watched two family Members die of Alzheimer's and we're currently nursing through a couple of friends helping them through a similar situation, I think it gives me kind of a different perspective on things. And I'd like to make a couple of points.

The first one is the first question that we asked when my family Members got Alzheimer's wasn't what programs could help us. It was more, where do we go now? What do we do now?

I think the OCD and I network would be a big help in answering those questions by the map and direction, where people are going, a place to go. The second point I'd like to make is in my former life, I was a quality insurance Executive for the IBM Corporation.

So I tend to think about things from a business standpoint. And a couple of things struck me on the Medicare growth 340 to 300 and some million dollars during my IBM day. If we saw that, we did not think about it doing business.

We looked at it as a preventative opportunity to prevent failure downstream by redesigning some processes on the system. And I think the An Eye Network is that redesign in the case of Alzheimer's and dementia. So those are my two points. Thank you for hearing the testimony.

Thank you for being here. On Zoom. I believe we have Barbara Black.

Hello, Good morning. My name is Barbara Black and I live in Ninoli on the Big Island. I strongly support this bill. I'm the caregiver for my spouse, Peter Black, who lives with Alzheimer's. He was diagnosed about 10 years ago. But we were very lucky in an early diagnosis.

And it was possible only because we have the ability to go to Oahu and the mainland. Not everyone can do that. That relatively early diagnosis was a great gift to us. As we contemplated our future, we were able to plan how we would manage this disease as it inevitably progresses.

I've had the opportunity to learn more about the disease and about caregiving during this time. Caregiving for a spouse with Alzheimer's is complex and difficult. The ability to adjust and learn as early as possible has helped me immensely. Early detection also provides the possibility of early access to treatment to slow progression.

Peter was able to begin treatment with one of the new drugs. This access to early detection treatment and quality coordinated support should be easily available and accessible to everyone dealing with this disease and on their home islands.

The dementia crisis in Hawaii is growing and this new Hanae memory network would offer a statewide solution and provide this much needed help. Thank you for allowing me to testify.

Thank you.

Now next we have Peter Black.

Hang on. Okay, I'm here. My name is Peter Black. I'm a retired professor of anthropology. I got my diagnosis good 10 years ago because my wife suggested I go to Honolulu and see a neurologist because I was worried about my mind. I got the diagnosis. I've been living with Alzheimer's ever since.

I consider myself fortunate for a number of reasons. First of all, I have what the doctor calls cognitive reserve, which just the fact that I spent my life reading books and giving lectures, thinking things out and writing stuff down, I can't do much of that anymore, but it's helped.

The second reason I see all these lucky as I got that early diagnosis because as Barbara said, she and I were able to rationally plan, carefully work out how we were going to deal with this thing that was going to eat away at my mind.

And so there are people in this world that we really love and we made sure we got in touch with them. There are things in this world we really wanted to do and we did them as well as we could, when we could. And now we're just moving along.

So I just urge you, if at all possible, to support this Bill because I shouldn't be the only person who feels they are lucky in their Alzheimer's. Anybody who gets an early diagnosis. Is. Going to be lucky.

And if they're living on one of the outer islands or in a very rural area without access to dementia care, they're not going to learn that. And it'll be years later maybe. That. The consequences come forward. Thank you for allowing me to testify.

Thank you, Mr. And Mrs. Black. We really appreciate your testimony. Thank you.

See, we have written Comments in support from nine other individuals. Anyone else I missed who wishes to please step forward?

Chair Takayama, Chair Marten and Members of the Committee. My name is Calvin Hara. I'm advocating for the 31,000 people here in Hawaii with Alzheimer's. We need action, not deferral, so families across our state continue to experience long delays in diagnosis, limited access to specialists and a fragmented system of care.

Far too often families are left to navigate this disease on their own at moments of crisis with little guidance or coordination. I appreciate this version of the Bill because it's both strategic and fiscally responsible. Understanding the state budget is tight this year.

The Hanoi Memory Network establishes a statewide structure and begins implementation on one neighbor island with one dementia specialist and one memory care. This is a thoughtful and realistic first step.

The long term vision is to ensure that every island has access to clinical dementia expertise and strong, clearly defined linkages between community providers and specialized care as emphasized by Mr. Black. By continuing this structure now, Hawaii can ensure that all residents, regardless of where they live, have access to the highest quality dementia care. Planning and ongoing support.

This Bill is modeled after proven programs in other states and represents the beginning of a program that can truly transform how we as a state address Alzheimer's disease, shifting from a fragmented approach to a coordinated, equitable and compassionate system of care. I respectfully urge your support for the Hanoi Memory Network. Bill Mahalanui for the opportunity.

Thank you Mr. Hara.

Anyone else wishing to testify? Members, any questions? Seeing none, let's move on. House Bill 1973 regarding a kupuna Loha program to provide in home health care and support services. State Health Planning and Development Agency Dr. Jack Lewin.

Good morning Chairs, Vice Chairs and Members of the Committee. The Kupuna Aloha program was born from the Kupuna Advisory Council of SHPDA. More than 20 people worked on this gerontologist. A whole variety of disciplines came together to think about an unmet need in our state.

One that costs a lot of money and that is the large number of Kupuna who are not eligible for Medicaid. That's the vast majority. And Medicare does not provide home health services except in very, very extreme circumstances. Therefore, these people are, you know, they're just isolated from the care and needs.

The Kabuna Loa program will work with CHWs where they exist. We just don't have enough of them. Will build volunteers. I might need to say what CHW.

Community health workers where we have them and but volunteers now we have programs like Hui Ohaula Project Dana and a number of volunteer programs that are unfunded but tremendously valuable in the state.

Those folks came together and they're building, working with churches and other community organizations to identify volunteers who will be vetted, trained, given an Ipad and a connection to always available advanced practice nurse or social worker to answer questions.

The program with these frontline workers will be connected back to the primary care source, whoever takes care of those patients originally to actually be the front line for primary care for these folks. It's not going to cost very much money to do this program, but it will save ton of money.

We have requested $2 million a year for Kupun Aloha in the rural Health Transformation piece. This Bill however, came out of the Kupuna caucus here in the Legislature to deal with the majority of those folks who would not be covered because they're in urban areas.

So this is, this program is the extension to those folks that aren't rural areas. And I thank you very much for your support of this Bill. We think it's going to save a lot of money and do wonderful things.

Thank you Dr. Department of Health.

Good morning. Chairs, Vice Chairs, Members of the Committees Lauren Kim Department of Health Planning and Policy Officer we support the intent of this. We agree with, with everything Dr. Lewin said. Kunalohe is a win, win, win, win win situation. Providers, payers, communities, families and the Kupuna themselves.

And as Dr. Lewin indicated, it was part of our very well received rural health transformation program proposal to cms. We have identified it as an early priority, but we do not have authorization to expend funds yet. So we would like to keep the Legislature apprised of the progress of RHTP and specifically the KPUNA Loha line item.

And we encourage this body to keep this measure moving in the event that we can. There are, there are funds and resources to focus on the urban core and you know, Korumu basically. So we will keep you folks in the loop and we'll watch this all session long and I'm available for questions. Thank you. Okay, thank you.

Executive Office on Aging on zoom.

My apologies. Aloha Chair Caroline Cadirao, Director of the Executive Office on Aging. We support the intent of this bill and just offer some comments. We really like the idea. We see a lot of parallels with some of our current systems like the Aging and Disability Resource center, our kupuna care program.

So we really look forward to working with SHPDA and to ensure that we map out our respective service systems eligibility requirements so that we're not duplicating but really integrating our, our systems and our funding resources and working with Department of Health. And I'm available for any questions. Thank you.

Okay, thank you. See, we have testimony in written form from four individuals in support. Anyone else wishing to testify on House Bill 1973, seeing none. Members, any questions?

Dr. Lewis, if you don't mind, thank you so much and thank you for your work on the Rural Health Transformative Health Care Grant. You know, you. In the Testimony we saw $2 million. I was just really curious how you arrived at that number.

At the 2 million. 2 million. It's not enough to do a full statewide program, but that was what we felt was we could start with and demonstrate the success and then expand it.

The program's going to have kind of at the top level, there's going to be a home health kind of expertise to make sure that the individual referred to the program because they're frail or high risk will get a thorough assessment first, a professional assessment, the volunteer or chw then be trained in terms of that person's particular needs and connect it back to the primary care source to make it work.

It's probably going to be more like a 6,000,000 dollar program statewide if we, if we decide to go fully out there.

But we're, we're thinking that just giving this a start and if we, if we're lucky enough to get the, the money approved, which I think will happen in rural health transformation, this money would then provide service for many other people that would otherwise be ineligible there. So hopefully that investment will pay off.

Yeah. If you could just kind of keep tabs on that. We just want to make sure that the delta that we're using to formulate these asks that metrics. Right. I just want to make sure as we move forward.

Yes, thank you for that. I think Senator Moriwakee and the Kupuna caucus felt that there was going to be a need both for the rural health side and the urban side, which is how these two parallel proposals have emerged.

Great. Thanks, Dr. Dui.

Thank you.

Let's see. Any other questions? Seeing none. Let's move on to the final Bill on the agenda, which is House Bill 1974, appropriating funds to State Health Planning and Development Agency to develop a state plan on hearing loss. First up, State Health Planning and Development Agency.

Good morning again. Thank you. Jack Lewin, SHPDA Administrator. This program really came again out of SHPDA because of our statewide advisory councils who help us understand how we're doing in healthcare in general on a geographic basis. And we also have some focused councils and the notion that hearing loss wasn't being addressed well, has come.

Has arisen multiple times. That's where this, this kind of emerged. The program will probably. This planning process is. There's no dollar in there, but it's about $100,000. It's a very small request to get to really understand how many people need services.

We had some people actually serving with us who had sudden deafness, you know, in their 30s that no one could really ever diagnose properly. How did it happen? Is it a viral infection? We're not sure. But in addition to that, there's obviously kids, KQ who need the services and there's lots of seniors.

So we want to assess where the issues are and then come back with a plan later to really deal with the issues of deafness, which can have disabling effects on. On people, obviously. So that's. That's where we're coming from.

Here available for questions. Thank you, doctor. And just for the record, the Bill actually does contain the sum of $100,000 in proposed procreation. Okay, good. Thank you. Let's see. Alzheimer's Association, Kobe Chok.

Rep. Takayama and Members of the committees. We stand on our working testimony and support. We just want to note that hearing loss is one of the preventable risk factors of Alzheimer's and dementia. So for that reason, we support this measure and making sure we keep everyone healthy. Thank you.

Okay, thank you. See, we have the Executive office on Aging and Support here for Hope Tori Carafello in support. Let's see, we have written testimony from. Oh, I'm sorry, are you on zoom? I'm on zoom. Tori.

This is Tori Caripello. Thank you. Thank you so much. I'm sorry I'm not there today, but aloha. My name is Tori Caripello and I am the founder of Year for Hope. I'm actually here both as a community advocate and someone who has lived experience. In 2021, I experienced sudden hearing loss.

I remember being told that there was nothing they can do anymore and that this was something that I was going to have to learn to live with. In that moment, I was just losing my. It wasn't just about losing my hearing. It was about losing confidence, independence, and the ability to communicate.

What made it even harder was realizing that there was no clear path forward. The diagnosis was addressed, but there was no roadmap, no coordination, no guidance, and no clear place to turn to for support.

I also learned that hearing devices were just not enough education, assistive tools and ongoing support are what made the difference between isolation and participation. And too many people, they don't have access to that. Like, I was fortunate, but others are not. The experience led me to start here for hope because there was. There was no.

I wanted to make sure that nobody had to navigate hearing loss in such a fragmented system, you know, through our work, we hear the same story again and again. People don't know where to go. Care pathways are confusing. Providers are stretched in, and services are disconnected. Hearing loss affects far more than just hearing.

It impacts communication, employment independence, and quality of life. And as the Hawaii population continues to age, the challenges will only grow. House Bill 1974 is an important opportunity for us to take a proactive, coordinated approach. A statewide plan would help identify gaps. We'd be able to strengthen early detection.

We'd also be able to support workforce development and ensure community voices are part of that solution. You know, from both my lived experience and my work within the community, I can clearly say that a need is real, the gap is significant, and, you know, the cost of inaction is high. So mahalo for the opportunity to testify, and I respectfully urge you to support this Bill. Thank you.

Thank you. Anyone else wishing to testify on House Bill 1974? Members, any questions? Seeing none. Let's move on to decision-making. Thank you all for your patience. And. So our decision-making begins with House Bill 2315 relating to Department of Health Employee Benefits.

I'd like to move this forward as a House draft with technical corrections for style and consistency, as well as defecting the effective date. Any questions, comments or concerns, if not Vice Chair for the board.

Thank you, Chair. Chair's recommendation is to pass with amendments. [Roll Call] Chair, your recommendation is adopted.

Thank you. Next up is House Bill 2562 relating to workplace finance in healthcare settings. I agree that this bill is very well intentioned. I do hear concerns from the State Department of Health and labor regarding its ability to enforce this measure.

I would like to work with the author of this bill as well as supporters in the nursing profession, because I'm not certain that this bill is the right vehicle to move forward. So with the assurance that we'll continue to work on this, I'd like to defer this bill. Thank you, Jeff.

Next up, House Bill 1532 relating to tobacco products. As I announced earlier, we'll defer this bill because the author has asked for an Opportunity to do further collaboration with the Attorney General's office and burning of the bill. The next bill is House Bill 1857 relating to defining qualified healthcare providers. Like to move forward with the House draft.

As I announced earlier, we're going to use the Senate vehicle SB2491 to work on this very detailed and lengthy bill. And I've been assured by the respective Senate committees which is at this moment working on the bill, that they will move it forward. So I'd like to add a defective date to this bill and move it.

Keep it alive as a House trap. Members, any questions, comments or concerns? If not, thank you, Chair.

Members voting on House Bill 1857. Chair's recommendation is to pass with amendments. Voting all Members present. Any Members voting with reservation? Any Members voting no? Chair, your recommendation is adopted.

Thank you. This next bill, House Bill 2209, requiring health insurance carriers to honor a patient's written assignment of benefits to treatment providers. I think Insurance Commissioner as well as HMSA raised some legitimate concerns that are worth examining further. So I'd like to work further on this bill along with the proponents and for now at least defer this.

Next up, we have HB 1961 regarding interference with person's access to health care facilities. I'd like to move this forward as a House draft, agreeing to the amendments proposed by Planned Parenthood which would remove the trespass and noise sections because they are already covered by existing law.

Add technical amendments for style and clarity as well as defecting the effective date. Members, questions, comments or concerns? Representative Garcia.

Thank you, Chair. Just a comment. While I strongly support protecting patients and ensuring a safe access to health care care, this bill goes far beyond that purpose. As written, it opens the door to criminalizing peaceful, lawful speech and Assembly directly. Directly targeting pro life advocates who are simply exercising their First Amendment rights.

We already have laws to address true harassment, threats and violence. We should not use public safety as a cover to silence other viewpoints when we disagree. And for those reasons, I'll be voting no. Thank you.

Thank you. Thank you, Representative. Representative Alcos.

Thank you. Any other comments or questions? If not, I'll Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 1961. Chair's recommendation is to pass with amendments noting no votes from Member Alcos and Garcia. Any other Members voting no. Any others with reservations? Chair, your recommendation is adopted. It.

Thank you. Next Bill, HB 2343, Maui Veterans Home. Would like to move this forward as a House draft. Simply defecting the date and making certain Technical amendments, Questions or comments? Vice chair for the vote?

Yes. Members voting on House Bill 2343, Chair's recommendation is to pass with amendments noting all Members present. Any Members with reservations. Any Members voting? No. Chair, your recommendation is adopted.

Thank you. House Bill 2160 relating to the Hawaii Cancer Research Special Fund. Like to move this forward as a house draft. There is a blank amount in appropriations, but that's because the amount that is appropriated has to be calculated by the Tax Department. So we leave that blank and. And we'll put in a defective date. So with those with that change. Members, any questions or comments? Vice chair.

Thank you, Chair. Members voting on House Bill 2160, Chair's recommendation is to pass with amendments noting all Members present. Any Members voting with reservations? Any Members voting there? No. Chair, your recommendation? Chair, your recommendation is adopted.

Thank you very much. Next Bill, House Bill 2505 relating to assisted community treatment. Like to move this forward as a house draft removing the five day requirement as well as adding the Department of Health suggestion that we add to the language community health outpatient programs as petitioners for acts as well as any other necessary amendments to clarify what's proposed in the Bill and also added effective questions. Comments? Vice chair?

Yes. Thank you, Chair. Members, House Bill 2505, Chair's recommendation is to passed with amendments noting all Members present any with reservations.

Reservations.

Thank you, Member Alcos. And thank you, Member Garcia.

We're hearing your reservation.

Any other Members voting? No. Chair, your recommendation is adopted.

Thank you. Now for the next several items on the agenda. These are jointly referred to both health and Human Services Services Committee. First is House Bill 1537, operating funds for the Department of Health for early intervention mental health services.

I'd like to move this forward as a house draft, taking the proposed amount of appropriation of $3 million, blanking it out and putting it in report language. Changing the report date to the Legislature as reporting to the 2028 Legislature rather than the 2027 and also defecting the effective date. Questions? Comments? If not, Vice Chair for the vote.

Thank you, Chair. Members on House Bill 1537 noting all Members present any with reservation. Reservations? Thank you, Mr. Garcia. Any voting? No. Chair, your recommendation is adopted.

For the community on human services, same.

Recommendation when HB 1537 chairs recommendations to pass with amendments noting the with reservations of representative Garcia. Any Members voting reservations? Any voting? No. I'd like to change my two reservations. Please for both sides. Thank you.

No problem. For human services, can you change a. Vote yeah okay that's great.

That's fine.

But it will be noted in the human services vote. Okay, thank you.

Chair, your recommendations adopted.

Next bill House Bill 1562 appropriating funds for a one year digital youth mental health platform pilot project like to move this forward as a house draft putting the proposed amount of $300,000 blanking it out putting in report language also adding to the report language suggestion that this platform also address gender issues.

On the part of. Youth and adolescents and also add a defective date Questions, comments or concerns? Vice Chair for the vote.

Thank you, Chair. Members on House Bill 1562 Chair's recommendation is to pass with amendments. Noting all Members present. Any voting with reservations? Any voting no? Thank you Mr. Garcia. Chair your recommendation is adopted

For the Community of Human Services, same recommendation.

Voting HB 1562 Chairs recommendations to pass with amendments. Noting the no from Representative Garcia. Any other Members voting no or with reservations? Chair, your recommendation is adopted thank you.

House Bill 1731 relating to community care followers foster family homes I hear the concerns expressed by the state departments with jurisdiction over this. I. I do think it's important that we keep this measure alive if only to encourage their continued cooperation with each other and moving this forward.

So I'd like to simply add a defective date and Questions or comments?

Comments Chair yes please. I would just like to add to the comment to your recommendation that it's.

It's clear to me that there is a need especially on the neighbor islands and so I am in total agreement that we should move this bill forward and try to work on it so that we can try and get this as far as possible.

So thank you representative. I totally agree which is why I think we should keep the bill alive. Thank you Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 1731 Chair's recommendation is to pass with amendments. Noting all Members present. Any with reservations? Any voting no? Thank you Member. Chair, your recommendation is adopted.

For the Committee on Human Services, same recommendation.

Voting HB 1731 Chairs recommendations to pass amendments. Any Members voting no? With reservations. Recommendations adopted Thank you.

House Bill 1853 establishing the HANA Memory network program like to excuse me blank out the proposed amount of $3 million and put it in the report language as well as defecting the effective date. Members, any questions or comments? Vice Chair for the vote.

Thank you, Chair. Members on House Bill 1853 Chair's recommendation is to pass with amendments. Noting all Members present. Any with reservations? Any voting no? Chair, your recommendation is adopted.

Thank you House Bill 19

Hold on. Human Services, same recommendation.

Voting on HB 1853 Chair's recommendations passed with amendment. Any Members voting no or with reservations? Chair recommendation is adopted.

Thank you very much. House Bill 1973 establishing the Kupuna Loha program. Like to move this forward as a House draft clarifying that with language. Clarifying that this is a proposed one year pilot project. I also put in the proposed $2 million appropriation in the report language, technical amendments for style, consistency and clarity and finally a defective date.

Questions? Comments? If not Vice Chair.

Thank you Chair. Members voting on House Bill 1973 Chair's recommendation is to pass with amendments. Noting all Members present. Any with reservation? Any voting no? Chair, your recommendation is adopted.

For the Committee on Human services, same recommendation.

On HB 1973 Chairs recommendations to pass with amendments. Any Members voting? No with reservations? Chair recommendation is adopted.

Thank you. The final bill on the agenda, House Bill 1974 posting a state plan on hearing loss. Like to move this forward as a House draft putting the proposed amount of $100,000 in report language and blanking it out in the bill and adding a defective. Questions or comments? Not quite sure.

Thank you. Chair Members voting on House Bill 1974, Chair's recommendation is to pass with amendments, Noting all Members present. Any with reservations? Any voting no? Chair, your recommendation is adopted.

Services Committee, same recommendation.

On HB 1974 Chair's recommendations to pass with amendments. Any Members voting no? reservations? Chair your recommendations.

Thank you very much Members for your patience.

So just a note that we are adding a Committee hearing on Monday afternoon at 2pm we're working on the agenda. We got the last minute requests from Committee on Consumer Protection to to hear two bills. So we'll be issuing a Committee announcement in this afternoon.

So with that we're adjourned.