House Standing Committee on Health

Good morning, everyone. Welcome to this hearing of the House Committee on Health. It is Friday, February 13. Happy Friday the thirteenth. 9am, Room 329 in the State Capitol.

I'd like to welcome all of you for being here this morning at this early hour. Just a couple of housekeeping reminders. You you may notice if you haven't, testified here, prior to to well, before this, that, we don't have microphones this session. We have, microphones installed in the ceiling where the green lights are. So you'll notice that they're positioned over us, but not necessarily over you.

So when you do testify, we ask that you come up to the podium and speak in a clear, loud voice. We sometimes get complaints from members on the ends that they cannot hear clearly. For those on Zoom, we ask that you keep yourselves muted until we you're called up, and I do not show any trademark items while on the air. Because that's prohibited by YouTube. And reminder that we are on YouTube, so you're being watched by a worldwide audience.

We ask that the testifiers, we have a long agenda. Try and keep yourselves to, two minutes, if at all possible to leave room for other testifiers as well as questions. So with that, let's start with our first bill, which is House bill 1535 relating to automated establishing an income tax credit for installations of automated external defibrillator devices. And first up, we have the Department of Taxation.

Thank you. Department of Health.

Vice chair, vice chair, members of the committee. I'm Robert Aviallavi of Tax. The department stands on its written testimony providing comments, and I'm I'm here to answer any questions.

Good morning, chair, vice chair, committee members. Derek Hall, chief of EMS for the Department of Health. We stand on our written testimony and here to answer any questions you may have.

In support, I gather. Comments. Comments. Okay. On Zoom, I believe we have Tom Yamachika.

Text Foundation of Holyoke. Not present. Okay. We have written testimony from the Kohala Coast Resort Association in support. Building Owners and Managers Association of Hawaii in support.

On Zoom, Kaile Swan.

Good morning, chair, vice chair, and committee members. I'm a strong supporter of this measure because AED is most important in a community building settings. And, and I know that Skyline has AED on the both end of the cars in train station. But we know it's the auto transit vehicle has AED in your vehicle to case any cardiac emergency happens in a in a transit system. So if the passenger suffer a cardiac emergency.

So can you please pass this bill and please let me touch my hand if you want me to testify.

Thank you very much. Thank you for your testimony. Anyone else wishing to testify on this measure? Please step forward. Doctor.

Good morning, chair, vice chair, honorable members, Jack Lewin, shipped it. We we had time to write testimony for about 131 bills, but not for this one. I just wanna say as an internist and cardiologist, I'd be remiss if I didn't say this is a good idea. Thank you very much.

Thank you very much. Anyone else wishing to testify? Members, any questions? None. Let's, move on to the next bill.

House Bill 1765, establishing safety warning requirements for spearfishing gear. First up, we have Department of Land and Natural Resources.

Morning, chair, vice chair, committee members. My name is David Sakoda for Department of Land and Natural Resources. We stand on our written testimony offering comments, and I'd be happy to answer any questions. Thank you.

Okay. Thank you very much. Let's see, on Zoom, do we have, FreediveSafe! Hawaii, Niki Roderick?

Aloha, Chair. My name is Niki Roderick. I'm the Founder of FreediveSafe! Hawaii. I have been involved in freediving education since 2007 and over the past five years, excuse me, have provided structured free safety education to more than 3,000 Hawaii residents, 85% of whom participate in spearfishing.

Before attending our programs, fewer than 10% understood what hypoxic or shallow water blackout was. Free diver blackout happens suddenly and without warning. When proper safety protocols are not in place, it can quickly lead to drowning. I have personally experienced it five times. Education and outreach are essential.

I have dedicated years to that work. However, what I've consistently seen in the field is that awareness is not equal, especially among youth and first-time divers. Parents have repeatedly shared concerns about the lack of risk disclosure on equipment. A warning label is not a replacement for education; it is a starting point.

It encourages new divers and parents to seek out safety training. It reminds those who know to prioritize safety. The bill does not regulate diving activity, it does not restrict access to equipment, and it does not create enforcement in the water. It simply ensures clear disclosure of a known and documented risk at the point of sale.

Spearfishing is a respected and enduring practice in Hawaii. Clear risk awareness strengthens that tradition and protects the next generation who carry it forward. While some equipment is locally made, a substantial portion is imported and sold through larger retailers. The implementation cost is minimal, approximately 30¢ per sticker or point 3% of a $100 Polsphere, and reasonable solutions can ensure small local manufacturers are not burdened.

This is a practical and balanced measure. 50% of the 18 anonymous Hawaii freediving accident reports that I've reviewed specifically mentioned spear guns and pulse spears. It is the second leading activity associated with Hawaii resident ocean drownings, and participation continues to increase. Between 2013 and 2000...

I'm gonna ask you to please wrap up. Yes, please. Go ahead.

Thank you. When the risk is known, the harm is preventable, and the cost of disclosure is minimal, and we have a responsibility to warn. Mahalo for your time.

Thank you so much. Anyone else wishing to testify on this matter? Seeing none. Members, any questions? Seeing none, let's move on.

Next bill is, House bill 1549, repealing proposing to repeal the law prohibiting drug paraphernalia. And first up, we have, doctor Jack Lewin, one of a 135, testimonies.

Good morning, chair and vice chair. Jack Lewin, chair administrator of SHPTA. This bill really is just this doesn't in any way promote drug use. It just is a means of preventing drug overdoses for opioid users, not to mention a lot of waste time for police department folks as well. So we think this bill is an important cleanup measure.

Thank you.

Thank you. Office of the Public Defender, in support. Department of Health.

Good morning, chair, vice chair, members of the committee. Tim O'Kornick with the Department of Health. The Department of Health appreciates the intent of this measure in providing comments focused on the public health implications. Drug paraphernalia legal restrictions on drug paraphernalia create barriers to individuals who use drug reducing their risk for infections, overdose, and injury. So we appreciate you considering this repeal.

Thank you.

Okay. Thank you. Let's see. We have, written testimony from the Maui County Prosecutor's Office as well as the police department in opposition. Honolulu Police Department on Zoom.

Yes. Good morning. Dear chair, Takayama and members, thank you. I am lieutenant Alan Booth. Sorry. Sorry. I think you may be muted. We can't hear we can see you, but can't hear you.

Okay. Let me try unmute you.

How is that? Could it be better?

Sorry. Yeah. I I think your mic volume is really low. If you can turn off your your volume. Sure.

Okay. How's that better? Can you hear me? How's that? Can you hear me, Chip?

Is that better? Hang on just a second. Wait.

Yeah.

Sorry about that. Let's see if we can get the volume up here. No. Can you hear me? That's alright.

We still are heavy. You know what? If we could, come back to you. Is that can we do that? Okay.

Well, while you work on that, let's move on to, Hawaii harm Hawaii Health and Harm Reduction Center. Heather Lusk.

Thank you so much chair, vice chair, and members of the committee. Heather Lusk with the Hawaii Health and Harm Reduction Center. We have run the statewide syringe exchange program since this legislature, codified that in 1993. So this exemption is for public health. You already heard that from from some of our previous speakers.

What we're seeing at the syringe access program is that because there is a carve out, for example, for syringes in the paraphernalia law, which again this legislature did so that people would not be afraid to bring contaminated needles that might spread blood borne pathogens to the exchange we're actually seeing the unintended consequence of people not wanting to inject but injecting because they don't have access to things like pikes because they are illegal under this statute.

This statute would provide protections for my team so that they could do public health interventions and provide these resources. So for example, we don't just do syringe exchange, we do drug treatment. We've had over a 100 people who used to use our services for drug use now accessing drug treatment. Many national organizations like the American Public Health Association and even the New England Journal of Medicine have published research that shows how supportive repealing drug paraphernalia laws are for public health. At the

same time, we understand the concerns of law enforcement. In fact, I work very closely with my law enforcement partners. They already have the tools that if somebody's breaking another law, if somebody's, selling or otherwise, you know, being attending, they have the tools available to arrest, detain and prosecute them. What we're seeing is individuals from paraphernalia not be willing to come and get services, die of overdose, get HIV and hepatitis.

And really, those are the concerns that we have and why we feel that this bill would not only address those public health concerns, but then allow my team to not have fear around arrest and then facilitate the health, access to drug treatment, and all the other services that these folks desperately need.

Thank you so much for listening to my testimony and the opportunity. I know this sounds counterintuitive, to actually repeal this. We actually know and see the data that it will not only help public health, but allow our law enforcement partners to focus on the true public safety issues in our country.

Thank you. Thank you. Thank you so much.

Well, h let's go back to HPD on Zoom. I think we can hear you now because we've been hearing you. Yes.

So sorry. Apologize. Thank you, chair and, chair Takayama and members. I am Lieutenant Alan Liu with the Honolulu Police Department speaking on behalf of Major John A. Paco, Major

of the Narcotics Vice Division.

The HPD opposes House Bill number fifteen forty nine. Our opposition is based on the concern that repealing drug paraphernalia laws could inadvertently encourage increased drug use and contribute to public health and safety issues. First, Decriminalizing Drug Paraphernalia may lead to easier access to items that support substance abuse, potentially normalizing drug use especially among youth and vulnerable populations. Public health research generally indicates that greater availability of drug paraphernalia can correlate with higher rates of substance abuse.

Second, unregulated paraphernalia could lead to public safety concerns such as discarded items in public spaces posing risks of injury or health hazards to the community.

The HPD respectfully urges you to oppose House Bill number one five four nine relating to controlled substances, and we thank you for this opportunity to testify. Thank you.

Thank thank

you, Lita. Let's see. We have testimony from Hep Free Hawaii as well as Drug Policy Forum of Hawaii in support. Three individuals, two in support, one of those. Anyone else wishing to testify on House Bill 1549?

Seeing none, members, any questions? Seeing none, let's move on. Next bill up is, HB 1550, excluding drug testing products from the definition of drug paraphernalia. And first up, we have, Department of Health.

Next bill up is HB 1550, excluding drug testing products from the definition of drug paraphernalia. And first up, we have Department of Health.

Chair, Vice Chair, members of the committee, Tim McCormack with the Department of Health. The department stands in support-- stands on our testimony in support, and we're here to answer any questions that you have. Thank you.

Okay. Dr. Jack Lewin, Bill 152.

Good morning, again, Chair, Vice Chair. Jack Lewin, SHPDA. We stand on our written testimony in support. Thank you.

Thank you. Hep Free Hawaii in support. Heather Lusk, Hawaii Harm and-- Hawaii Health and Harm Reduction Center.

Thank you, again, Chair, Vice Chairs, members of the committee. We strongly support this measure because we know it saves lives. Two years ago, this body--the legislature--did take fentanyl test strips out of the Paraphernalia Law and we have data that shows that that has saved lives.

While we still had over 100 fentanyl deaths unfortunately in the islands in 2025, we did see a small decrease, and the distribution of fentanyl test strips through opioid settlement money has been shown to be effective. So this measure would also allow other types of drugs to be tested and not have that at the end of the Paraphernalia Law. So thank you again for the opportunity to testify, but this bill will save people from fatal overdoses. Thank you.

Okay. Thank you.

See, we have written testimony from David Fukuzawa in opposition. Anyone else wishing to testify on House Bill 1550? Seeing none. Members, questions? Seeing none, let's move on. House Bill 1995, providing that people who are blind or deaf can receive a disabled parking permit. First up, we have Hawaii State Council on Developmental Disabilities.

Chair and committee members, Hawaii State Council on Developmental Disabilities stands on its written testimony in opposition. Thank you.

In opposition. Okay. Disability and Communication Access Board.

Hi. DCAB will stand on its testimony in opposition.

In opposition. Okay. National Federation of the Blind of Hawaii, on Zoom. Not present. In opposition. James Gashel, in opposition. On Zoom, Katie Keim. Not present. She was in opposition. We have written testimony from Peter Fritz and Sheri Shimizu in support, and four individuals in opposition. So, members, any questions? I'm sorry. Anyone else wishing to testify on House Bill 1995? Okay. Seeing none.

Okay. We're making rapid progress. Okay. Let's move on. House Bill 1671, allowing a licensed dental hygienist to place their interim therapeutic restorations in public health settings.

Department of Health. In support. Thank you. In support. Okay.

DCCA Board of Dentistry. Hello, mister. I'm the executive officer for the Hawaii Board of Dentistry. This time, the board has not met to establish a formal position, but they'd like to stand on the written testimony offering comments on the bill. Okay. We have Kokuakulihe Valley, comprehensive family services and support. Hawaii Dental Association offering comments. On Zoom, we have AlohaCare.

Not present. Not present, in support. On Zoom. Hawaii Oral Health Coalition.

Hi. Good morning, chair, vice chair, and members of the committee. I'm Patrick Donnelly with the Hawaii Oral Health Coalition, which is a program of Hawaii Public Health Institute, and we stand on a written testimony in support for this measure. I'm happy to answer any questions. Thank you so much for the opportunity.

Okay. Let's see. Hawaii Dental Service in support. Hawaii Dental Hygienist Association in support. Grassroot Institute of Hawaii in support.

Let's see. We have two, four, five individuals six individuals with written testimony in support. Anyone else I missed who, wishes to testify on this measure? Seeing none, members, questions? Okay.

Thank you. We'll move on to, House Bill 1643 three, specifying a framework for audits of records of pharmacists and pharmacies. Department of Health?

Good morning, chair Takayama, vice chair, Kiyohokafulu Eloy, members of the committee. My name is Michael Burke. I'm with the Hawaii State Department of Health who's a drug branch. We submitted written testimony offering comments on this measure. Stand on our written testimony, and I'm available for questions. Thank you. Thank you.

Okay. Thank you. DCCA Board of Pharmacy.

Good morning, chair, members of the committee. Christopher Fernandez, executive officer to the Board of Pharmacy. The board I'm here to stand on the board's testimony, supporting the intent of the bill and offering comments. Thank you.

K. Before you go, I just, note that in your testimony, you do have some concerns about the bill. You wanna just briefly summarize Yeah.

Sure. Sure. Sure.

Your concern.

Yes.

So the board, when they met, last week, noted that they felt that this was a, public safety issue in the sense that the consumer protection issue, because of the the significant number of audits that pharmacies can go through, which can take away from patient care.

That's your concern? Yes. Thank you very much. Let's see. HMSA, Walden

Thank you, chair. Welcome to the committee. Walden Howe on behalf of HMSA. We support the intent of the measure, but we just have a couple of questions that we'd like to raise for the committee to consider. The recent passage of multiple PBM reform provisions by Congress in the CA of 2026. We're just not sure how the provisions of this measure would align with those that are forthcoming federal regulations that will be put.

We're just not sure how the provisions of this measure would align with those that are forthcoming federal regulations that will be put.

And secondly, we're also a little concerned that some of the proposed limitations and requirements on the recruitment of overpayment really well and the consequences that could undermine program integrity efforts. Ultimately, these types of provisions could restrict the ability to address patterns of race, abuse, and fraud for contractual noncompliance and do not high threshold of criminal fraud, but nevertheless, it holds cost on the health care system. We appreciate the opportunity to present these concerns, and thank you.

proposed limitations and requirements on the recruitment of overpayment really well and the consequences that could undermine program integrity efforts. Ultimately, these types of provisions could restrict the ability to address patterns of race, abuse, and fraud for contractual noncompliance and do not high threshold of criminal fraud, but nevertheless, it holds cost on the health care system. We appreciate the opportunity to present these concerns, and thank you.

Hawaii, Pharmacist Association, Corey Sanders.

Morning, chair Takahama, vice chair Keohokapal Lieloy, members of the committee. Corey Sanders, executive director of the Hawaii Pharmacists Association will stand on our testimony in strong support. Some additional comments that were brought up by HMSA, which I think are really reasonable. The PBM reforms that were just passed by Congress aren't gonna go into effect until 2020 and 2029.

A lot of the initiatives that are intended in this bill to protect the independent pharmacies across our islands that serve our most remote and underserved populations may not have until 2028 until 2029 to be protected by the audits that are currently in place that the pharmacies undergo.

So it really is time sensitive that we're putting a framework in place in the state. This audit bill was taken from a couple other states that use similar provisions. So if there are updates at the federal level that need to be managed at the state level, we're happy to do so afterwards.

And then in terms of the contractual agreements that they have in place, if there are certain recommendations that you all have that we need to take into consideration in order to keep this moving forward, we're happy to get to it. But I really do just wanna emphasize the audits that our independent pharmacies are undergoing are strikingly different from the ones that the major pharmacies are undergoing that are affiliated with these bigger PBMs.

It's often thousands of prescriptions that are being audited. They're given very limited amount of time to prepare for these audits, and it's ultimately taking away from patient care and providing some patient safety issues that support a pharmacy set. So we're happy to work with HMSA if they have specific considerations, but I wanna emphasize that time is of the essence to protect our independent pharmacies. Thank you.

Thank you. Molokai drugs.

Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and committee members. My name is Kimberly Mikami Svetin, and I am the president of Molokai Drugs. On behalf of the 6,500 residents of Molokai, I respectfully submit testimony in strong support of HB 1643, which would establish a fair framework for pharmacy audits and record retrieval in the state of Hawaii. Molokai Drugs is a rural community pharmacy, and we have been providing services to Molokai and her people since 1935.

Molokai Drugs provides prescription drugs for many on our island, especially our kupuna. We manage over 700 patients in a synchronization program so they only have to come in once a month, we deliver to homebound kupuna for free, we call providers all over the state for patients' refill requests, and we call and text our patients to confirm that they have no refills and need to see their doctors. Our pharmacist in charge is responsible for coordinating all prescription audits from prescription benefit management companies and insurance companies. We are audited almost every week by PBMs and insurance companies.

In fact, we just received a four-page audit on Wednesday by fax and we have seven days to do that audit. There are two types of audits that we coordinate: in-person and desk audit. For the in-person audits, some of the PBMs will pay a mainland-based employee to fly to Hawaii, stay at hotels, pay for meals and incidentals, charge for rental cars, taxis, and Ubers. A lot of us have experienced these over the years.

We had a short break during COVID but they're back in play again. A desk audit is one that we got on Wednesday and is sent by fax. The audit we received on Wednesday was a desk audit. Our pharmacist in charge would coordinate all of the documents required. We would then fax or mail these documents back to the PBM. These audits could easily be done by desk audit at a much lesser price.

This would save state and federal taxpayers, insurance companies, PBMs, and clients millions of dollars a year. As a rural healthcare provider, our goal is to provide access to comprehensive, high-quality healthcare services at Molokai. Thank you for your time, and I'm here for any questions after the fact.

Thank you. On Zoom, Leanne Malapit. Not present. She was-- she's in support. Let's see. We have Mauliola Pharmacy, written testimony in support, KTA Pharmacy in support, as well as two other individuals. Anyone I miss wishing to testify on this bill, HB 1643? Seeing none. Members, surely there are questions.

Aloha, Chair. Sorry. I do have a question. For HMSA. So in HMSA's testimony, they make references to possible misalignment, and I'm curious as to what HMSA has identified as misalignments to the federal act with this proposed bill.

So, thank you, Rep. I think we're still currently looking at what the regulations would be coming down from the <unintelligible>. As it-- even though it goes into place in 2029, we are already gonna start as soon as we understand what they're regulating to align our own practices to meet the federal standards. If state-- or different state regulations come into place, there'll be two kind of diverging paths that have to go.

Okay. And just to clarify, that possible diversion of paths would not occur until at least 2028?

Well, we're gonna start-- I mean, I would assume it as soon as Q2 of this year, implementing, you know, the framework of what's required from Congress. Should this bill pass, we would also have to start that path forward to meet state regulation.

Okay. Thank you. No further questions, Chair.

Thank you. Any other questions from members? Seeing none, I do have a question for the Pharmacists Association, Corrie Sanders. You heard the testimony from the State Board of Pharmacy expressing concerns about the provisions of the bill and that it may actually increase a workload of pharmacists and pharmacies.

So we were intending--

Do you--

Yeah. I don't think that that was the intent. Right now, the audits of--

Oh, that's not the intent of the testimony or the intent of--

Yeah, I don't think that was supposed to be addressed as a concern, correct?

The board is concerned that the audits proposed in this measure may increase pharmacists' and pharmacies' workload in a manner that could compromise patient safety. Am I misreading?

It's-- it's in-- sort of confusing, but I could explain.

Okay.

Sorry, Chair. The board can explain your confusion. Sorry, Chair. I think the testimony was just referring to the types of audits that are within the bill in the preamble and such, so sorry about that misunderstanding, but the board has figured that the audits wouldn't-- the audits increase the workloads. So I think the way it was written, I apologize. It was confusing.

Are you-- just to clarify, so you're suggesting that the existing audits increase workload and what is proposed in this bill will not increase labor workload?

Correct.

Okay.

But you said you had concerns about the bill. Or do you have concerns about the present situation?

The present situation. Sorry.

Thank you.

Sorry, Chair. And I apologize again.

No, no. No problem at all. I'm glad you clarified. But, let's see. I do have a question for Ms. Sanders. So we-- you heard the testimony that there are federal regulations, and you mentioned that as well. So, does it make sense to maybe hold off until federal regulations take place--

I think that what we're--

Sure. I think that's a very reasonable question. I think what we're proposing is a framework that just doesn't exist at all, and I see that a lot of the-- or if I could predict, I think a lot of what the federal regulations are gonna impose is really similar to what we're proposing. These are very common-sense provisions.

--in 2028?

It's the amount of time before an audit, the number of prescriptions before an audit. It allows the pharmacies to plan in advance. There's nothing that's done in this bill that isn't already being done in different frameworks across the country, so I predict that we're gonna be hopefully in alignment with what the federal regulations do propose.

Certainly, if there is divergence, then yes, that would be a bit of a concern, but because of the amount of money that our independents are losing because there is no framework for audits whatsoever, I think the negative implications of doing nothing outweigh the diversions that maybe we can go back and modify in statute moving forward, because right now these audits are not done in good practice. A lot of times, if there's nothing to ding the pharmacist on financially, the auditors will sit there and keep asking for prescriptions until they find something that they can financially take back from the pharmacy.

They're losing tens of thousands of dollars in most cases from these audits. So having a framework that ensures that auditing is done in good standing for the first couple years until the federal guidelines go into place, I think, is more important than waiting for them to come in place <unintelligible>.

Okay. Thank you.

Morning, chair, vice chair, members of the committee. I'm Edward Chu of Hawaii Health Systems Corporation. We'll stand on our written testimony in strong support. I'll be happy to answer any questions. Thanks very much.

Thank you. On Zoom, Queen's Health Systems.

Yes. Thank you, chair. We largely stand on our written testimony. Did want to provide just a couple updates. So the Queen's board has appropriated the first $30,000,000 to select the architect and finalize the drawings of the property.

We continue to work with the Kona community hospital and HHSC's teams to develop their timelines and make sure that we're making the right investments back in the community. Just want to appreciate, everyone who has supported this bill, including our Governor, county community, the entire community, and HHSC. Thank you.

Thank you. On Zoom, Kona Kohala Chamber of Commerce.

Aloha, Chair Takayama, Vice Chair Keohokapu-Lee Loy, and members of the House Committee on Health. I'm Wendy Larrick, and I'm the President and CEO of the Kona Kohala Chamber. Since 1968, our organization has advanced the quality of life in West Hawaii by supporting a strong sustainable economy on Hawaii Island.

Representing more than 460 member businesses leading voice for the West White business community and advocate for policies that support long term community stability and regional economic growth. The Kona Kohala Chamber strongly supports and urges passage of HB 1978 relating to the West Hawaii regional health care system.

Access to health care is directly tied to workforce stability, business retention, and overall community well-being. Without adequate health care infrastructure, West Hawaii faces increasing challenges in recruiting and retaining physicians and health care professionals. A new hospital will not only improve health outcomes in our community, but it will also strengthen our workforce, create quality jobs, and support the long term economic future of our region.

We applaud the partnership between West Hawaii Region of Hawaii Health Systems Corporation, that is the community, Kona Community Hospital, and the Queen's Health Systems. This collaboration represents a serious long term investment in West Hawaii and establishes a clear path toward developing a what a future, a future full service hospital in Kona.

This type of public private partnership is exactly what is needed to address the complex regional health care needs. West Hawaii cannot afford to delay progress on health care infrastructure. Our community workforce and economy depend on it.

For these reasons, we respectfully urge you to pass HD 1978 relating to the West Hawaii Regional Healthcare System. Mahalo for this opportunity to testify.

Thank you. See, we have a written testimony from the Mayor of Hawaii as well as Council Member Michelle Galimba. Testimonies from several organizations, including Kohala Coast Resort Association, Ali’l Health Cente, and four individuals. Anyone else wishing to testify on House Bill 1978?

Seeing none. Members, questions?

None? Okay. Let's move on. House Bill 22.

Yeah. Thank you, chair, vice chair, members. Our testimony somehow was was not filed correctly. SHPDA the stands in strong support of this measure. It's surely needed.

Our advisory councils on the Big Island have strongly supported it. And we think this partnership between Queen's and HHSC is also a very positive thing. We stand in strong support. Thank you.

K. Thank you very much. Once again, any other anyone else Members, questions? Seeing none, let's move on to, hospital twenty two twenty nine Authorizing Micro Enterprise home kitchens to prepare and sell food directly to consumers. First up, Department of Health.

Good morning. Aloha. Greg Kapyama and vice chair, Kino Kapioli, a member for the health committee. My name is Peter Oshiro. I'm the program manager for the Department of Health's food safety branch.

Here to give testimony on behalf of the director. The department recognizes the value of supporting small businesses and appreciates that the bill also recognizes the importance of food safety standards. However, the department has serious concerns that authorizing any sale of time temperature control for safety foods without adequate training or regulatory controls will have serious negative public health outcomes as these foods carry the highest risk of making people sick.

Time temperature controls for safety foods is a scientifically defensible food safety concept promoted by the US FDA and food safety experts. TCS foods recognize that strict time and temperature controls must be implemented to prevent the proliferation of pathogens and toxin formation in certain foods and food preparation methods.

TCS foods pose the highest risk for foodborne illnesses, and common TCS foods include animal products such as beef, pork, poultry, fish, eggs, dairy, and cooked starches and plants such as cooked rice, pasta, and baked potatoes. On a federal level, the 2022 US FDA model food code does not allow home kitchens to be used for the commercial preparation of food. These are considered unapproved food sources if it comes out of people's homes.

While many state and local jurisdictions have adopted laws allowing certain homemade food products to be produced, packaged, and sold with limited oversight, these exemptions are safest when limited to non TCS foods as currently allowed under Hawaii law. In August 2025, the department expanded the definition of our homemade food products as directed by the passage of act one ninety five in 2024 to include non TCS and non potentially hazardous foods.

Homemade food products are required to be properly labeled to indicate that they are not made in a DOH inspected facility. And the operators of these homemade food operations also must complete basic food safety training such as food handler certification. Just keep in mind that the expansion of the homemade food products bill, under this measure, conflicts with the measure which is passed that, expand the homemade food products allowance. So I'm, waiting for any questions to get me.

Thanks. Thank you. On Zoom, Hawaii Food Industry Association.

Good morning, chair, vice chair, and members of the committee. I'm Alexis Chapman for Hawaii Food Industry Association. We stand on our testimony and support, and I'd be happy to answer any questions.

Also on Zoom, Angela Young. Not present. Not present. See, we have grassroots, Grassroot Institute of Hawaii in support, Hawaii Food Policy found the Purple Maia Foundation in support, as well as, individual, Ben Kagiman. Anyone else wishing Tesla and Hospital twenty two twenty nine?

Members, questions? I have a question.

No. Or just a minute of follow-up, please.

Good morning.

Thank you for your testimony. And it looks like this bill kind of creates kind of a space in between a home kitchen and a commercial kitchen. And what I read in your testimony is really it's unknown what type of products will be developed in the farm kitchen.

I think that's not this bill.

Farm is in the

Oh, I'm so sorry. I'm so sorry.

I'll be actually Why that?

You'll know the answer when you come up. I'll throw the evil time.

Yeah. Give them a tactic.

If there's any other questions? Seeing none, let's move on to the next bill since we're anxious to move in. House bill 2619 relating to homemade food products authorizing farm kitchens on the same basis as home kitchens. First up, Department of Health.

Hi. Good morning. Again, Peter Oshiro, home program manager for the Department's Food Safety branch. Actually, we really don't have much concern with this bill and we don't stand in opposition to this. If you have any questions, I'd be glad to ask.

Hawaii Food Industry Association on Zoom.

Good morning again, chair, vice chair, and members the committee. I'm Alexis Chapman for HFIA. We stand on our testimony in support, and I'd be happy to answer any questions. Thank

you. Hawaii Farm Bureau in support. Grassroot Institute of Hawaii in support. Maui Chamber of Commerce in support. One, two, three individuals in support.

Angela Young, is she on Zunya? No. None support. Anyone else wishing to stand still? Members?

Questions, vice chair.

Department of Health. So you're my question. Right? I I think what we're trying to do is slice in something in between home kitchen and commercial kitchen. Is Department of Health tasked with creating the rules and process for evaluating a home kitchen or farm kitchen?

Well, let me clarify that. We actually allow home kitchens to operate free of any permits or oversight. So they just have to, basically label their products and take a food safety class, and that's actually about it. So we don't inspect. We have no standards of what needs to be in a home kitchen to qualify.

Okay. And so this would come under that same definition.

Right. We have no objections to a farm kitchen being classified as a home kitchen and our only thing is I'm gonna throw in the kitchen sink. Right? And that's it. Our only concern is Literally.

We would have a kitchen sink, and that would be the only requirement, and that's for washing hands. Great.

Thank you. Thank you so much.

Yes.

So, yeah. So you had written your testimony, you said you just weren't sure what a farm kitchen meant. Correct. So do you have language? And is is that language what you just said that they should have a sink?

The legislature to provide that language and they would comment on if if for us to clarify and allow this bill to pass, we could simply say, a farm kitchen would be a kitchen that includes the same, and that would be it. To redefine farm kitchen to include it with the homemade food product. It it's that simple for us. Yeah. We don't see any.

Thank you,

Representative Komaki?

Thank you. Just to follow-up. So the sink requirement, I guess, is there a temperature requirement

for the water needing No. Need to be able to have wash with warm water?

There is not. Yeah. Okay.

Yeah. On the national level, they do require for commercial. But in Hawaii, we actually waive that because the water is temperate year round. So the cold water in zero degrees here doesn't happen where people won't wash their hands off. Yeah.

We don't we kinda waive that hot water requirement on the hand sink only, only, not for dishwashing.

Thank you. Thank you, chair. Okay.

Alright. Good. Any other questions? Okay. If not, let's go on to, cost bill twenty three nineteen relating to the State Health Planning and Development Agency, also known as thanks for doctor Jack Lewin.

Thank you. First up, doctor Dean.

Good morning, chair, vice chair, and honorable members. SHPTA is a fifty year old agency in terms of functioning this year. It was statutorily created in 1975 with super broad vision as an agency to kind of be the sort of health authority for the state to think about the future of health care. It had significant federal funding. And over the years, that funding went away, and the residual part of of SHPTA has been largely a certificate of need for the ensuing years.

But the statutory authority is still there. This bill modernizes the authority by saying that the definition of health care includes the setting. It can be the home, the school, or the street. It also includes, a few things that we should include in health care, oral health, behavioral health, and long term care. It finally summarizes a whole lot of of, language to really kind of focus as our our our function is universe is is ensuring universal access to high quality, equitable, and affordable health care for all.

In addition, and ask us to look together with the other, very excellent services across the state in so many agencies to reduce the siloed effect. And as a state, think of a big vision. What are we doing together? DOH, DHS, DCCA, the Department of Education, Corrections and Rehabilitation, HHSC, University of Hawaii. And so our job really is not to no regulatory authority over those things.

It's the art of collaboration and persuasion to say what should we be doing together? And if we can do that as a state, we could bring the the private sector in for the same kind of large scale vision. We'd like to do that. This bill doesn't increase our regulatory authority at all. It decreases it slightly by exempting the Department of Health from the certificate of need functions.

So we look forward to, modernizing our statute. Thank you very much for this testimony.

Thank you very much. Hawaii Association of Health Plans, Rachel Wilkinson.

Good morning, chair, vice chair, members of the committee. Rachel Wilkinson on behalf of the Hawaii Association of Health Plans providing comments. While we appreciate the efforts of lawmakers to make it easier for Hawaii's health system to adapt to capacity needs and health care facilities, we do have quest concerns with section two of the bill, which would assign new responsibilities to SHBTA. HB 2319 proposes that SHIFTA take on complex regulatory and policy functions that already fall within the jurisdiction of multiple specialized agencies.

And we believe that adding to these responsibilities to SHIFTA risk duplicating efforts and creating overlapping authority, which could slow decision making and reduce transparency.

For these reasons, we respectfully oppose section two and recommend removing this language to avoid unintended consequences and maintain SHIFTA's current issue. Thank you for the opportunity to testify.

So just to clarify, are you suggesting that all of Section two that's not almost the entire adult be eliminated or just a part of Section two?

Section two, page three.

Onto page three.

Lines one through 10.

Okay. Lines one through 10. Okay. Thank you very much. So HMSA.

Chair, vice chair, members of the committee, all the help of HMSA. We really do appreciate the intent of this measure. It's been great to work with doctor Lewin, and we continue our conversations with all this bill with other measures across how that impact health care. We share similar concerns with half.

So solely on the section or subsection two that's found on page three lines one through 10. While it may not explicitly give ship the rate making or other powers, we feel that it may be duplicative as that falls under the purview of insurance commissioner. Those types of activities, I believe, could already happen should the ICC consultation with Chipville. Appreciate the opportunity to testify.

Thank you. Okay. Thank you. And let's see. We have written testimony in support from Rashford Institute of Hawaii as well as, an individual, William Beech.

Anyone else wishing to testify in hospital twenty three nineteen? Seeing none, members questions.

Representative Lamont.

Yes, please.

Thank you, chair. Question for doctor Lewin, please. Thank you for being here. So I'm, you know, it seems like many of the insurance companies are concerned that this bill will actually increase your powers at SHIPDA. My concern is more in the re redefining of the term health care.

Is it possible I mean, that so it's to going to be narrowed to the improvement of a person's health. Could that potentially create litigation issues? What if a person has chronic health conditions that are not improved per se under that definition?

It's to promote the improvement of health. So I I don't see any conflict there, actually. I think we're the intent is to for each individual, wherever they are, wherever their health conditions are, our job would be to help envision the way to promote better health and population health in general.

And those with the chronic condition where their health just generally doesn't improve, it may simply maintains a current level that's not in any sort of conflict with that definition?

I don't think so. I I think that, you know, the eye for people with chronic diseases, they there's still an intention to try to maximize their potential to live their lives fully, And we think that falls within this description.

Thank you. Thank you, chair. Thank you. Members, any other questions?

I have a question. Perfect. For doctor Lewin.

So, how do you respond to the, concerns about that Section two?

Yes, ma'am.

Yeah. I I would say that this was reviewed very thoroughly with the attorney general and is not an expansion in any which way of any regulatory authority. We might notice that SHIPTA currently seems, thanks to the legislators legislature support, all of the insurance claims data from all companies in the state. Certainly, we should have the right to report back what you see without being a regular.

We just simply want people to be alerted to where gaps in health care exist that we wanna correct and fill together.

But we see this as a collaboration role. I work very closely with HMSA on a variety of issues and with the other insurers out here. We're partners in this. We have

to work with hospitals, insurers, providers across the spectrum, and the other government agencies. So I don't see this as a conflict, but I understand their concern. It's just not one that the attorney general or ship to Greece is is very real. Thank you.

Just, Doctor. Nguyen, just to to clarify the the, lines through, one through 10 that, on page three that, HMSA as well as health insurers talk about, says that you shall conduct health planning activities of the State to assess and address gaps or concerns affecting access, quality, and cost, including but not limited to health insurance coverage and rates, health insurance benefits and affordability, workforce development, and several other items. So you're saying this doesn't bestow you on you any

new It it doesn't. Actually, it doesn't. Maybe if the public wants to know about cost of care, we wanna be a resource for that. On the other hand, I don't mind if those if the insurance words are removed from the bill, it will make no difference because we'll continue to report on the data, for example, that we're pulling out of the all payer claims database and so forth. We intend to partner with the insurers on this.

We're all working together if we wanna succeed in Hawaii.

Okay. Thank you very much. But I wouldn't take all the lines out because I think it really moves most of the meaning of the bill. Thank you.

Okay. Got it. There being no other questions, let's move on to hospital twenty one seventy three appropriating funds for an advanced life support ambulance in Central Maui. First up, doctor Jack Lewin.

Thank you, chair, vice chair, and honorable members. This is an absolutely important need for Central Maui. The population is growing there and for and not only just for the the ambulance service itself, but connection to air ambulance support services. So this is definitely a very important need for the state, and, we partly support the bill. Thank you.

Thank you. Department of Health.

Good morning, chair, vice chair, committee members. Garrett Hall, chief of EMS for the Department of Health. We stand on our written testimony in support of this initiative. I'm here to answer any questions.

Just while you're up here, can you I think in your testimony, you mentioned the projected cost of this?

Yes. So it's it's right now, it's costing us 1,700,000 to establish a new EMS unit. Any new units, so that includes the actual vehicle, the actual location of the unit, and the staff to staff it twenty four seven, along with maintenance and ongoing all the expenses. Once we purchase the vehicle, it goes down to about 1,200,000 annually per year to staff and maintain a twenty four seven EMS unit.

So for purposes of this bill, you're asking 1,750,000?

Yes, sir.

Okay. Thank you.

Let's see. We have testimony from Maui Councilmember Alice Lee, chair Hawaii Medical Association and support as well as one, two, three, four individuals. Anyone else wanna testify on 2173?

Yes. ... AMR. That is strong support. Strong support from AMR. Okay. Anyone else? Members, any questions?

Okay. House Bill 2576 authorizing authorizing applicants, operators, and third party employers other than Department of Health to conduct background checks of employees and adult volunteers. First up, the Attorney General Office.

Morning, chair, vice chair, and committee members. My name is Phil Higdon. I serve as the administrator of Hawaii Criminal Justice Data Center. The department attorney general has submitted written testimony in opposition to this bill solely regarding the collection of fingerprints and related approval process. As currently drafted the lang the language granting authority to those authorized to conduct fingerprint background checks and access criminal history information is overly broad.

For a Non Criminal Justice Agency to obtain criminal history information including arrest and conviction information, the FBI Criminal Justice Information Law Unit which is commonly known as CJLO must review the enacted state statute and grants the authority. The CJALU evaluates whether the statute complies with public law 92-544 before approving access to criminal history information. It's important to note that if amendments are made to the current statute, it's highly unlikely that CJLO will approve access to criminal history information.

Without that approval, licensing bodies and healthcare facilities that rely on comprehensive background checks could be significantly affected as they would only have access to conviction information, not arrest information until the statute is changed. Thank you.

I'm willing to answer any questions.

Thank you. Department of Health.

Morning, chair, vice chair, members of the committee. My name is Paula Serios. I am chief for OCA for the Department of Health. We stand on our written testimony in opposition of this measure, but I wanted to provide some additional comments. So in 2023 the United States Office of the Inspector General nursing homes in Hawaii and found that our state was not ensuring compliance with federal health and safety requirements under 42 CFR part 483.

These regulations along with CMS guidance, the Centers for Medicare and Medicaid Services clearly prohibit the employment of individuals with histories of abuse, neglect, or exploitation. That means that criminal background checks are not optional. They are required of nursing homes to be able to receive payment from Medicare and Medicaid. Once it became clear that CMS requires us with nursing facilities, we believe all healthcare providers should share the same commitment to patient safety.

Patients in hospital and hospitals and long term care facilities are among our most vulnerable and they all deserve to be protected.

The FBI fingerprint check is the national standard because it provides consistency and accuracy across all states. It is a one time fingerprint that ensures we catch convictions anywhere in the country. We recognize this is a business business expense for providers, but there is no price on patient safety. Most licensed facilities are already complying with the current statute, proving this is both feasible and effective. Our department is committed to working with the Healthcare Association of Hawaii to find practical solutions that uphold safety while supporting providers.

While there is a federal regulatory requirement for certain healthcare providers, ultimately, this is about trust and protection that should be expected from all healthcare providers. Eliminating the fingerprinting requirement sends a concerning message about our commitment to patient safety and the standards we uphold to protect those in our care. We urge you to support measures that strengthen compliance and safeguard the people who depend on us most. Available for questions if needed.

Thank you. Healthcare Association of Hawaii.

Good morning.

Hilton Hilton Raethel, president and CEO of the Healthcare Association of Hawaii. And its members are committed to creating a safe and secure environment for patients, residents, visitors, and staff. Our members have been conducted comprehensive name based background checks for many years. HRS 321-15.2 was passed in 2006 and subsequently amended requiring fingerprinting of health care employees as part of a background check process. The Office of Healthcare Assurance did not start enforcing the 2006 law for approximately seventeen years.

We're not aware of any specific action or malfeasance on the part of healthcare employees that prompted OCAH to begin enforcing the law seventeen years after it was passed. We can find no federal requirements for fingerprinting of health care employees. The fingerprinting requirement in the 2006 law and as interpreted by OCAH has a number of issues. It is an expensive, unfunded mandate. It is operationally challenging to implement, and it has, in our opinion, an unnecessarily broad reach.

HAH is proposing that Hawaii revised statutes be amended to remove the requirement of fingerprinting as part of the background check process and that comprehensive name based background checks be conducted both as a condition of employment and on regular intervals thereafter. Thank you for the opportunity to testify.

Queen's Health System.

Aloha, chair, vice chair, Jacce Mikulanec, and I come on behalf of the Queen's Health System. We'll stand largely in our written testimony, and I just wanna underscore, that we too are looking forward to collaborating with the Department of Health. We've been attempting and trying to do that for the last five or six months.

If these kinds of complex policies are gonna be put on health care systems to carry out, we just need to be have the, work done ahead of time so that we can plan for that financially and implementation wise. So, we agree with the amendments and comments by and, HPH. Thank you.

Thank you. Hawaii Pacific Health.

Good afternoon, chair, vice chair. My name is Mike Robinson with Hawaii Pacific Health. You have our testimony in writing. I just wanna make a distinction. Hawaii Pacific Health and all of our hospitals, we are dedicated to having a safe workforce.

We do not have an issue with background checks. We have an issue specifically with fingerprinting, FBI fingerprinting. Especially when it's overly broad on elements of our workforce, it goes down to basically people even work in our cafeterias per our, per the way the statute's written. Many of our licensed professionals already participate in in FDA fingerprinting such as nursing. This would be another duplicative requirement on top of that that the employer be responsible to do on top of that.

We also have issues with the sole source vendor that the department has chosen, which we will have to pay for at $75 pop. I mean, that is an unfunded mandate that we had no conversation or input on. I think most troubling though is that this current statute puts us in a in a precarious position of being in violation of Hawaii State Employment Law.

In our state, we cannot look back more than ten years on a felony or seven years on a misdemeanor, and that that job must be rationally related to the offense before we can either terminate employee or not them into hire. The way the algorithm works with Fieldprint, which is their chosen vendor, it does not allow for accommodations to be made for those types of situations.

In an area where we are trying to increase our workforce, we're trying to get justice involved individuals and youth into the health care sector. Having somebody be subject additionally to FBI fingerprinting is something that we feel is gonna be a, a deterrent for all the workforce efforts that the state is trying to do as well as us. So we are concerned about this being applied to our current employees, and we are also, concerned about prospective employees.

I will also note, physicians right now in our state are not subject to FBI fingerprinting. There's been no conversation with the physician committee on how we would roll this out.

So we ask that you keep this bill alive so that we can keep Department of Health accountable and us as we work on solutions. It's a very technical bill that requires a measure on the house and the Senate to move forward. Thank you.

Thank you. Kaiser Permanente.

Morning chair, vice chair, members of the committee. Jonathan Chang for Kaiser Permanente. I'll largely also stand on our written testimony. I think the one thing that I just wanna highlight to amplify, I think, our testimony, which I think is very consistent with the the previous testifiers from the Health Care Association and the other hospital systems. But largely, I think the biggest problem that we've really had is, you know, it's been incredibly challenging to work with OCRA.

There's been inconsistent answers that they've provided and there just hasn't really been clear guidance, you know. I will say again, you know, we are very much in strong support of ensuring very robust background checks. The issue is really the fingerprinting. And, you know, similar to the the previous testifiers, you know, we really request that and hope that the committee would continue to move this vehicle forward.

It is a vehicle, I think, really to continue the conversation as we work hopefully with the administration to try to find some reasonable ground, that will still ensure, you know, high quality background checks, ensuring patient safety at the foremost, yet at the same time not creating, you know, overburdensome and and, you know, really having a, I would say, an adverse impact on operations of, you know, health care facilities.

We're available for any questions and really appreciate the chair for scheduling this measure. Appreciate it.

Thank you. On Zoom, Rehabilitation Hospital of the Pacific.

Hi. Good morning. I am Stephanie Nadolny, president and CEO of the Rehab Hospital of the Pacific. Thanks for providing this opportunity this morning for the bill to check our support for this bill. Rehab serves a highly vulnerable population, individuals who've experienced life altering illnesses and injuries, including a high number of consumers.

Our organization is committed to contracting comprehensive background checks for our staff, students, and volunteers, virtually everyone who comes into contact with our patients. We use a highly qualified third party vendor to complete background checks, even verifying that someone doesn't embellish their education or prior work experience. Rehab adheres to all existing requirements for background checks, and we are confident that anyone who should not be near a vulnerable populations is successfully screwed out.

Adding fingerprinting to the background check process is unnecessary and adds administrative burden to an already overtaxed system. This process would be resource intensive, expensive, and does not provide value to our patients.

I would rather put additional dollars towards activities that enhance the care of our patients versus another administrative group to jump through that does not effectively improve patient safety. We should not continue to try to fix things that are not permanent. Fingerprinting should not be tied to the facility licensure. Nurses in Hawaii can already complete fingerprinting with their licensure requirements.

One viable solution is to tie fingerprinting to professional licensure where maybe more of a session can be done on a judicious basis for the most appropriate licensure groups instead of casting such a wide net.

To be clear, rehab is fully in support of robust background checks for health care providers, including volunteers and students who we have firmly imposed to its patent fingerprinting. Thank you for your time.

Thank you. Let's see. We have, testimony from, Professional Background Screening Association, Rory Bogdan, offering comments. Hawaii Health Systems Corporation in support, as well as Hawaii Care Choices. Anyone else wishing to testify at House Bill 2576?

Seeing none members, questions? Yes. Representative Takenouchi?

Just a couple clarifying questions for Department of Health, please. Thanks for being here. So I think there's a lot of conversation around the FBI fingerprinting aspect of it. And when I read through the testimony, I know there's some conflicting things. I just wanted to ask some clarifying questions.

First, I think the first thing I noticed is in the department's testimony, it says that the FBI fingerprinting is a requirement for the centers of Medicare and Medicaid services, and I noticed HEE said that they couldn't find that requirement anywhere. Is there a specific rule or citation in federal law that you guys pulled out?

Yeah. So in 42 CFR part four eighty three, it talks about the requirement for providers health care providers and specifically this was when the OIG came and did their audit. They referenced that in their report to us, that nursing homes specifically needed to make sure that they were clearing employees and not hiring anybody who had a disqualifying event. Right?

So there was that. So it's CFR, 42 CFR four eighty three point twelve and then parenthesis a, parenthesis three. And then also in CMS, their State Operations Manual, Appendix PPF606, also references that facilities must be thorough in their investigation of the histories of prospective staff.

And that specifically requires the FBI fingerprinting?

Yes. According to the OIG, it's implicit that the background check is comprehensive and done a federal FBI check. I know. The 2023 audit that you're sending, is that a public document that's available? Available on OIG's website, but I can send it.

Would you be prepared to give it to the chair, and then chair has to be. Yeah. To the committee member can email it to you?

And then I think the second thing I just wanted to clarify was I think there's this kind of question about that seems to be coming from the health care facilities about what is covered and then the I guess, not the purpose of but, I guess, you know, like, what maybe the fingerprinting is subpointing to what they're already currently. Because they're all saying they're already doing background checks.

So is there some kind of access to different kinds of information that the FBI fingerprinting is providing, or, like, is it covering different things that are not being covered in the background checks, other things that they're already done?

Yeah. So there are different ways to do background checks. They can be done named background checks, Social Security number, you can look at a variety of different things. Our information is that the federal fingerprinting, is the most comprehensive and looks at every single state, and looks at and I don't know if someone from the Criminal Justice Data Center or the AG could speak more clearly to this, but it is a comprehensive check that is looking at criminal history. And our understanding is that it's much more thorough.

It is also something that I stated earlier with the OIG and CMS that they require specifically a nursing facility.

So the current back, how does that compare so it's the criminal aspect of the background check across all 50 states is what you're looking to specifically get from the FBI fingerprinting. Okay. And then you think that's that's lacking in the background checks the health care facilities are currently doing in their main background checks. Okay.

And I guess I know this issue of the access of fingerprinting is something I and, I mean, I I've heard this from some of the care home operators of work I've done with them previously. And so is the department looking to expand access with another vendor or provider in the state to kinda help with this? Because this is not a new issue. Right? It's a kind of a long standing issue with this access to the fingerprinting.

So my understanding with places where the fingerprinting can be done on the island, there's I I wanna say on this island, there are 14 or 16 different places where people can go get their fingerprinting done. Other islands, it's gonna be a little bit different. And for, areas where it's a bigger issue like I think on Lanai. They can go to their their local police department and get fingerprinting done there.

So we certainly would be very supportive of expanding access and having more sites to have that done.

In terms of a different vendor, our understand my understanding is that Fieldprint is the only vendor in Hawaii. That's not to say that another vendor couldn't come in. I don't know. They're also the vendor for the criminal justice data center. So I I don't know the, you know, process to that, but we it's certainly not something that we would look to prevent.

It just they would need to have a contract with the department.

Yes. I guess my point is, because, I mean, for these kind of conversations, right, if, like, this is a big issue in community, like, if the department is seeing that I I you know, I've never had the department come and tell us, like, hey. Like, this is really impacting things. We need more resources and funding so we can expand this access to kinda help solve the issue is kinda my point. Yes. Maybe that's something we can work with.

Right now, we have 1,600 providers that are following this mandate and have been for years. So it is proven successful. It they're getting it done.

Albeit not on the same scale as a hospital. Right? I mean, these are much smaller providers, but they're going and getting the fingerprinting done for whether it's a care home or it's a home care agency or nursing, the nursing homes are starting to be in compliance with that now too, so they're obviously doing that as well.

So if we need more sites, we can certainly look at that, but Fieldprint also needs to have people that are accessing those sites regularly in order for them to be feasible for them to open. Right.

Thank you. And sorry, Chair, one quick follow-up.

Actually, maybe for Healthcare Association of Hawaii. One more clarifying question. I guess, in the same line of this. So this issue with, that all long term care facilities across all states require paint printing, is that accurate? I don't think you're working with other partners.

Sure.

Yeah. We, in our research, have not found that to be a requirement in all states. And if I could just clarify, we'll look for the particular, reference to to CFR. Our understanding of the current requirement for all health care facilities that are Medicare and Medicaid certified, including our long term care facilities, and we actually did, confirm this with our national affiliate who looks at all states, is that there is no federal requirement.

What what the what the regs say is that background checks must follow state law.

So it's a little bit circular so that if the state law says that you have to do fingerprinting, then you have to do that per federal requirements. But the federal requirements do not anywhere say, that you have to do fingerprinting. That's run through the FBI database. So just to to kinda answer it a little bit more directly, no. Based on our research, not every state requires fingerprinting for long term care facilities, and most don't require it for all health care facilities as a condition of licensure.

And the current member background checks, that or or the current sorry. The current background checks that are being done based on the name based thing, what what kind of coverage does that have for the criminal acts that, you know, DOH is saying they're looking for with that across, like, the other states?

Yes. They are national. They check every state, and they often go into the county records, which the FBI database, does not go into as much from our understanding.

My understanding is that these name based background checks and it's a little bit of a misnomer. Right? It's not just names. It's Social Security number, birthday, previous names. Anything that doesn't match up, that's how you can find if someone has used a a different name previously.

Right? My maiden name would come up. If I was using an alias, a lot of times that's how you can catch if it's not, you know, hooking up with the other kind of a personal identifying information. Our understanding is that the databases that are searched are more up to date. The issue with the FBI database is it is very contingent on states updating it, and our understanding is that states have a wide range of how often they're actually inputting data.

And so sometimes it's pretty immediate, but sometimes it can be a three or four month lag that you're seeing data from that particular entity, whereas the background checks are using data where they're going in more immediately to look. Thank you, sir. Yes.

So, just when you were discussing this circular state regulation of what a background check entails, Would changing that happen in the definition that's included in this bill, but which rather than taking out a background check, adds it in or adds in fingerprints? How would that change happen?

Yeah. Well, how we've written our suggested amendments on how to do this is to change the definition of background check to exclude fingerprinting. If there is a better way to do it, right, we can we can discuss, with our members and with our stakeholders and with the legislature. But currently, our amendment does suggest changing the definition of background check to exclude fingerprinting. Okay. Thank you.

Okay. Thank you.

I have a follow-up, please. In in changing the definition of background check, would that also then impact other areas? I'm I'm curious. Like, for example, if you're applying to become a licensed childcare home provider, you're required to go through a background check. So if we did a broad change of that definition, there are likely other areas that would be impacted. I'd be concerned about that. Is it can you speak to that or perhaps there's someone else here who's better people?

And, you know, I'm I'm sensitive to that. Right? I have a I have a child in a childcare facility, and I wanna make sure that, you know, he's safe with his teachers. And and we wanna make sure that everyone is safe. Right?

In our facilities, everyone who needs to go through a background check should be vetted appropriately. The way that we've written it, it it currently would only change the definition of background check, which is not referencing any other definition in 03/2002, which specifically relates to health care facilities that includes our members. So our hope is that this change, doesn't change anything. If we need to look if that definition is referenced in other statutes, we can do that. But our hope is that it's pretty targeted.

Thank you.

Any other questions? If not, first of all, I'll confess that I'm confused. But, Attorney General's office, could you, come up, please?

Absolutely. Thank you, sir.

I'm I'm a little bit baffled because, state says feds require fingerprinting. Hospitals and other facilities say not so, and, obviously, we can clarify. Can you clarify?

I'm gonna try. I'll try the best I can. So non criminal justice agencies who want arrest and conviction information, states can enact a statute, but that statute has to be reviewed by the FBI and there's certain criteria. If that criteria isn't met, then that agency, that Non Criminal Justice Agency, is not going to get rest information. In the state of Hawaii and other states, not all states, arrest information is confidential.

So as far as background checks, you're only getting conviction information. You are not getting arrest information. So it's very important to understand that you're missing a piece of the pie here is somebody's criminal history. So federal law, it's the public state statute. You can act in that state statute, but it has to be reviewed by the FBI.

If they approve it, then that agency, DOH and then designee, can obtain arrest and conviction information. If this statute is changed in any way, it goes back to they're only gonna be able to get conviction information until the statute is changed And it would be once again, reviewed by the FBI. And then, unfortunately, the FBI no longer reviews draft legislation. So we're talking an eighteen month period of approval or denial.

So if I hear you correctly, you're saying that fingerprinting is a full proof way of getting arrests, convictions, everything else, as opposed to just doing a a name background check?

The only way to positive positively identify an individual is by biometrics or fingerprinting. Name based finger name based check is not foolproof. Somebody can have the exact same name, exact same date of birth and all you're doing is checking that name. I I can I can my wife, same first name, middle name, last name, date of birth. Not here, but on the Mainland.

The middle name was Lynn, l Y N N L Y N. They came to arrest her. She had to show more proof that that wasn't the individual. What I'm saying is for a positive identification, the only method to make that positive identification is by fingerprints or biometric. If we believe that a name based check is is good, then the question is why are police departments, when they arrest people, why are they fingerprinting people?

Why not just give them a name? So the only way to make positive identification of an individual once again, I'm sorry I'm repeating, is by fingerprints and by biometrics. That's the only fight that that's the only dog that's the only fight that an issue I have I wanna raise as far as the fingerprints.

As far as, arrest record and criminal I mean, the conviction records Yes, sir. Is that it's contingent on the states and counties inputting the information to the national database. Correct?

Yes. So I I I've read some of the testimonies. So when an individual is arrested, okay, let's just say who lied, officers bring them into the booking station, they're fingerprinted. Those fingerprints run through the system, they come through our database, and then they're submitted to the FBI. That is in less than an eight hour period.

And that's the norm for nationwide. The information of somebody being arrested and it not being there for three or four months, I've never heard that I'm on many committees that with many states and I've never heard that.

Now as far as updating dispositions of an arrest, right, there could be some delays so an individual gets arrested that case goes to the prosecutors, they determine what they're going to do, whether they're going to prosecute or they're just going to, put it to the side and deny prosecution, whatever it may be.

That may be delayed by the prosecution's prosecutor's office not inputting the information as well as if the case goes to court and the individuals found guilty or not guilty, there may be a delay in the final disposition of that arrest, but an arrest is pretty there's no delays. It's it's what happens after the risk.

Okay. Alright. Thank you very much. Thank you, sir. There being no other questions, let's move on to the final move on the agenda. HB 2187 prohibiting health care facilities from furnishing medical debt to a consumer credit reporting agency. And first up, we have let's see.

Healthcare Association of Hawaii.

We'll stand on our speaker comments. Thank you.

Okay, Blood Cancer United in support, not present. Let's see, We have written testimony from 10 individuals in support. Anyone else wishing to testify on House Bill 2187? Health department?

So here, I'm with the Department of Health, and I apologize, we did not see this until late, but it does specifically state emergency medical services. We do want to just add comment that we do believe the reporting process does cause an added burden on the department and cost for us. I just wanna share some numbers with you. For the last two physical years, there were 2,609 EMS reports to collections, over $5,000,000 and only 200,000 collected.

It is a huge process, that we have to employ a collection agency to do and put on individuals, and it doesn't prove the results intended.

Plus, it does put individuals in a position where they are now afraid to call for 911 because they don't wanna have an additional bill put on their credit report.

So are you supporting the bill?

Comments. Just adding comments.

No position. Just comments. Okay.

Good morning, chair, vice chair, members of the committee. Mihoko Ito. I represent the Consumer Data Industry Association, which is a a trade association that includes, all consumer credit reporting agencies. So we submitted late testimony, and I really apologize that it was late, on this issue.

But we are concerned that this bill we submit our testimony is in opposition, and we are concerned that this bill is preempted by the Fair Credit Reporting Act, which governs, you know, many aspects of consumer credit reporting agencies as well as the furnishing of medical debt, information.

So, I just wanted to flag that for the committee that we believe as currently drafted that this bill may be preempted by federal law. Okay. Here to answer any questions.

Okay. Anyone else wishing to testify on this bill? 2187, Doctor. Lewin.

Thank you, chair, vice chair. We did not submit that testimony in the bill. I just like to comment that we are among the 38, wealthy nations of the OECD. We're the only one that accumulates medical debt on behalf of people in our society. It's shameful, actually.

But on the other hand, insurers, hospitals, providers, physicians, providers, and others are kind of subject to this situation we're in. And I defer to them and to the AG and others on how to solve the problem. I think that we need to solve it, however and probably the only way to do that is to really truly guarantee universal access to a defined benefit. That's where we need to go. Thank you very much.

Okay. Thank you. Anyone else wishing to testify here or on Zoom?

Seeing none, members questions?

Seeing none, let's move on to decision making.

Okay.

First up, we have hospital 1535 relating to AEDs and providing a tax credit for such. I'd like to move this forward. There's a blank in terms of places of employment. The blank in terms of how many employees should be covered. I'm gonna suggest that the supply to places with at least 25 employees.

That's been used as a standard in the past. Also, adopt the no tax amendments, to clarify certain definitions and other fixes as well. Also add a defect date. Questions, comments, or concerns? Vice chair for the vote.

Thank you, chair and members. Voting on House Bill 1535. Chair's recommendation is to pass with amendments. Chair votes aye. Vice Chair votes aye.

[roll call]

Chair, your recommendation is adopted.

Thank you. Next bill, HB 1765 relating to spearfishing safety. I'd like to move this forward as a House Draft. Making clear that the warning labels would be required effective 07/01/2027, but also put a defective date on the bill itself. And various technical amendments for clarification and style.

Questions, comments, concerns? If not, Vice chair.

Thank you, Chair. Members voting on House bill 1765. Chair's recommendation is to pass with amendments. Noting all members present, any members with reservations?

Reservations.

Reservations.

Thank you, Mister Alcos. Thank you, Mister Garcia. Any members voting no? Chair, your recommendation is adopted.

Next bill, HB 1549 repealing the law prohibiting drug paraphernalia. I can move this forward, as with a defective date. Members, any questions, comments, concerns?

Chair?

Representative, proceed.

I just wanna note that, many of our law enforcement agencies are in strong opposition to this Honolulu Police Department, and the Prosecutor's Office. So I'll do what you know. Thank you.

Okay. Rep, Alcos?

No.

Okay. Thank you very much. Vice chair.

Thank you, Chair. Members voting on House Bill 1549. Chair's recommendation is to pass noting all members present. No vote by Member Alcos and Member Garcia?

Yep.

Any others voting no? Any others with reservations?

Reservation.

Reservation.

Thank you, Member Olds and Member Hartsfield.

Thank you. Your recommendation is adopted.

Thank you. Next bill is, HB 1550, excluding drug testing products from definition of drug paraphernalia. Like to move this forward as a House Draft with a defective date, noting that this as well as the previous bills still both go to Judiciary and Hawaiian Affairs for further consideration. But I would like to keep it alive and move this forward as a House Draft with a defective issue. Questions, comments, concerns?

Vice chair for the vote.

Thank you, Chair and members. On House Bill 1550, chair's recommendation is to pass with amendments, noting all members present. Any members with reservation?

Any members voting no?

Chair, your recommendation is adopted.

Thank you. Next bill is House Bill 1995, providing disabled parking permits for people who are deaf or blind. I'd like to defer this. I know the public well intentioned to discuss this with the author of the bill, and I think this provides a forum for further discussion. But for now, we'll be fine.

But for now-- next bill is House Bill 1679-- that's House Bill 1671, allowing dental hygienists to place interim therapeutic restorations. I'd like to move this forward with technical amendments for style, consistency, et cetera, as well as a defective date. Questions, comments, concerns? If not, Vice Chair for the vote.

Thank you, Chair and members. House Bill 1671: Chair's recommendation is to pass with amendments. Noting all members present, any members with reservation? Any members voting no? Chair, your recommendation is adopted.

Okay. This next bill is House Bill 1643, relating to pharmacies. I know we had some discussion on this. I'd like to move this forward to keep it alive for the next committee to consider the consumer protection and commerce aspects. I'd like to move this forward as a House draft with several amendments.

First is to remove page 3, lines 19 and 20, because they're redundant with other language in the bill. Like to move this forward with several amendments proposed by the Pharmacy Association, first requiring electronic notice before audits are done--not just the initial audit but all audits. Notice must also include prescription number and date of the fill.

Second, allow 60 days rather than 30 days to address discrepancies. Third, audit may be conducted in HIPAA-compliant area outside the prescription department itself. Further, some technical amendments as well as a defective date. I'd like to move this forward with those changes. Questions, comments, concerns? If not, Vice Chair for the vote.

Thank you, Chair and members. On House Bill 1643, 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 1978, West Hawaii Regional healthcare system. I'd like to move this forward, simply removing the $50 million amount and place it in the report language along with the defective date. Questions, comments, concerns? Vice Chair.

Thank you, Chair and members. House Bill 1978: Chair's recommendation is to pass with amendments. Noting all members present, any members voting with reservation? Any members voting no? Chair, your recommendation is adopted.

Thank you. Next bill, House Bill 2229, relating to Microenterprise Home Kitchens. Bear with me, members. I'd like to move this forward as a House draft, first of all with technical amendments needed for clarity, consistency, and style. Second, on page 3, line 21, adding language in the definition of Microenterprise Home Kitchen, I'm making clear that the food that can be offered for sale can only be offered for direct to consumer sale.

Thank you.

Third, on page 6, line 2, adding language that prohibits operators of Microenterprise Kitchens from selling manufactured cannabis in addition to the sale of cannabis. I'm sorry. Manufactured cannabis products in addition to the sale of cannabis. Also, instructing the Department of Health to use its rules to add a section to provide for fines and penalties for violations of this, you know, statute, as well as a defective date. Members, questions, comments, concerns? Rep. Alcos? I'm sorry. You were looking at me. Okay. Vice Chair for the vote.

Thank you, Chair and members. On House Bill 2229, Chair's recommendation is to pass with amendments. Noting all members present, any members voting with reservations? Any voting no? Chair, your recommendation is adopted.

Okay. House Bill 2619 relating to homemade food products and farm kitchens and other words. I'd like to move this forward as a house draft also with a couple of clarifying amendments. First of all, adding language to require the DOH to adopt rules for farm kitchens that are not more stringent than those for home kitchens and homemade food products.

Secondly, on a defined farm kitchens as a home kitchen in which homemade food products are prepared.

Third, site specific definitions for home kitchens as well as homemade food products and making clear the definition in statute.

Fourth, defecting the date, as well as technical amendments for style, consistency, and clarity. I think that's it. Members, questions, comments, concerns? Vice chair for the vote.

Thank you, Chair and members. On House Bill 2619, chair's recommendation is to pass with amendments. Noting all members present, any members with reservation?

Any members voting no?

Chair, your recommendation is adopted.

Thank you. House bill 2319 relating to SHIPDA. I'd like to move this forward as a House Draft, defecting the effective date, noting also noting in the report language that, this measure is not intended to expand the regulatory authority of SHIPDA, particularly as it applies to insurance regulation.

Questions, comments, concerns?

If not, vice chair for the vote.

Thank you, chair and members. House bill 2319. Chair's recommendation is to pass with amendments. Noting all members present, any members with reservation?

Any voting no?

Chair, your recommendation is adopted.

Thank you. House Bill 2173, Maui Ambulance. I'd like to move this forward with a defective date, noting in report language that the requested amount is 1.75 million. Questions, comments, concerns? If not, Vice Chair for the vote.

Thank you, Chair. Members, House Bill 2173: Chair's recommendation is to pass with amendments. Noting all members present, any members with reservation? Any members voting no? Chair, your recommendation is adopted.

Okay. House Bill 2576 relating to background checks. I am still a little bit confused, but I'd like to keep the bill alive, if not simply to provide for ongoing dialogue with health facilities with the State Department of Health.

I'd like to move this forward as a House Draft removing fingerprints per the suggested amendments from the Healthcare Association. Also defecting the effective date and other technical, amendments to fix the bill.

Members, questions, comments, concerns?

Chair, just a comment.

Representative Hartsfield.

Thank you, Chair. I also agree that there needs to be more dialogue. I also see the benefit of including the finger printings because they include arrest records, which from my understanding, named background checks do not. And so for those reasons, I'll be voting with reservations.

I understand. Thank you. And like I said, you know, it's intended to move the the vote forward. By no means is it a finished cut. Any other comments?

If not, Vice chair for the vote.

Thank you, Chair. Members of House bill 2576. Chair's recommendation is to pass with amendments. Noting all members present and noting the reservation from Member Hartsfield. Any other members with reservations?

Reservations.

Reservations.

Reservations.

One, two, three, four.

Alright. Member Olds, Member Alcos, and Member Garcia. Any members voting no?

Chair, your recommendation is adopted.

Thank you. On this final bill, House Bill 2187, I'd like to move this forward to keep the measure alive. I'd like to defect the effective date as well as improve various technical amendments. Questions, comments, concerns? If not, Vice Chair for the vote.

Thank you, Chair. Members, House Bill 2187: Chair's recommendation is to pass with amendments. Noting all members present, any members with reservations? Any member-- oh. Thank you, Mr. Olds.

Reservations.

Thank you, Mr. Alcos.

Reservations.

Thank you, Mr. Garcia. Any members voting no? Chair, your recommendation is adopted.

Thank you. Members, before we adjourn, I'd just like to thank all of you for being patient. I know we've had lengthy agendas. I know we've had to start at 9:00 to accommodate them, but you've all been very cooperative and I appreciate that. For next week, our only hearing will be on Wednesday and we'll start at 10:00. So, thank you. With that, we're adjourned.