House Standing Committee on Health

Hi. Good morning, everyone.

Welcome to this morning's hearing of the House Committee on Health. It is Wednesday, February 18th, 9am here in Conference Room 329. Like to welcome all of you to our hearing. And just some housekeeping notes for those of you who are testifying.

We have no microphones on the table or at the podium, so they're built into the ceiling where the green lights show. And therefore, when you come up to the podium to testify, we ask that you speak in a clear and loud voice so that particularly Members on the ends of the table can hear you.

Well, the microphones do a good job by the way of picking up ambient sounds in the audience. So if you're whispering something badly about the testifier, we might all be able to hear it. So be careful.

For those on Zoom, we ask that you keep yourselves muted until it's your turn to speak and ask that you notice display any trademark items because we are being telecast on YouTube, so that is one of their restrictions. Finally, we ask that witnesses testifiers try and hold yourselves to about a two minute time limit.

We have a timer that you'll see and it'll ring gently. And if not, our Committee clerks will wrestle you to the ground and haul you off. But I'm just joking. Anyway, thank you very much for being here.

So we'll start off with the first bill, which is House Bill 1864, providing health insurance coverage for standard fertility preservative services for persons undergoing medically necessary treatment. And first up we have SHPDA Dr. Jack Lewin.

Good morning, Chair, Vice Chair, Honorable Members. SHPDA strongly supports this bill. We note that this is really routine coverage offered to almost all beneficiaries who need this kind of care on the mainland. Time for us to do this here. We think that the age 26 should be all women of childbearing age. Thank you very much. That.

I'm sorry, Dr. Le, if I could just clarify. You're saying that the coverage should apply to all women above the age of, well, childbearing age, adult and adult. Okay, thank you very much. Thank you. Let's see. We have written testimony from the Office of the Auditor, State of Hawaii, DCCA, Insurance Commissioner Concerns, Commissioner, Deputy Insurance.

Good morning, Chair, Vice Chair, Members of the Committee, Justin Chu for the Insurance Division. We just want to highlight from our testimony the potential for defrail under the Affordable Care Act. We note that the auditor highlighted a. Potential conflict in language in the measure. Regarding the use of a patient's history in determining limitations.

And then finally, we just note that the time to the 2018 American Society of Clinical Oncology guidelines differs from our state's medical necessity standards.

Thank you. Thank you very much.

Department of Health. Good morning. Chair, Vice Chair, Members of the Committee, Lauren Kim. For the Department of Health. Despite this measure having a ways to go with the sunrise analysis and Concurrent Resolution, this is a very consequential bill for many Members of our community going through a rough time.

And with that, the Department will stand on its testimony and support. We also appreciate Shipta's amendments to apply to women of all childbearing age. And we hope this conversation, very important conversation, continues. Thank you. Okay, thank you very much.

Let's see. We have written testimony and support from the Society of Clinical Oncology as well as the Fertility Institute of Hawaii, HMSA.

Good morning. Chair Takayama, Vice Chair Keohokapu-Lee Loy. Members of the Committee Walden Au, on behalf of HMSA, we stand in support of this measure and we actually like to really acknowledge all the stakeholders coming together to get to this point and we hope for your favorable consideration. Thank you.

Thank you. 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. In support, we recognize the importance of having access to fertility preservation services for individuals undergoing medically necessary treatments that may result in infertility.

Thank you.

Thank you. Let's see. Sasha Diamond.

Aloha Chair, Vice Chair and community Madam Members, my name is Sasha Diamond and I'm writing in strong support of this bill. I was diagnosed with breast cancer a few years ago and amongst that I had to deal with another reality of the chances of infertility.

My oncologist had recommended IVF due to the era irreversible damages that may happen to women's reproductive health. But in that I was supported through the Fertility Institute of Hawaii. And in the event that I would be able to have children, there's opportunities with advanced technology to test the embryo and so forth.

So it gave me reassurance that should I be ready, it would give me the opportunity to do so. So I did have to occur over $20,000 in charges to pay for these types of services. However, I believe that amongst others, there shouldn't be an age limit on that.

I do believe that it's a significant start for patients like me, but I don't believe that it should leave others behind. I did take that huge financial risk knowing that it's important to me. But I hope that you amend this Bill to include all residents struggling with infertility or facing medical induced fertility Regardless of their age. Thank you.

Thank you so much for your testimony.

Let's see, we have written testimony from. I counted at least 10 organizations in support. Is there anyone else in the audience or on Zoom wishing to testify in this bill? HB 1864. For seeing none. We'll open to questions from Members. Seeing none.

Let's move on to the next bill which is House Bill 2305 relating to or requiring that nutrition and metabolic education be a part of a physician's continuing medical education requirements. And first up we have Office of the Governor Will Kane in support. DCCA Hawaii Medical Board.

Sorry, Tori Nakata on behalf of Will Kane, Office of the Community.

Oh, I'm sorry, you heard.

Stand on our written testimony in support of this measure. We're here for questions. Thank you.

DCCA Hawaii Medical Board.

Chair Vice Chair Members of the Committee, Elizabeth Core for the Hawaii Medical Board. We appreciate the intent of this measure but respectfully oppose. If you you have our testimony in front of you.

Again, I would like to focus on the fact that CME is for the purpose of physician professional development and mandating specific topics as outlined in our testimony has been quite a slippery slope as other states have shifted CME requirements to a expanding list of statutory requirements. So if you have any other questions, I'd be.

Thank you very much.

Dr. Jack Lewin SHPDA.

Hello Chair, Vice Chair. Jack Lewin. We stand on our written testimony in support.

Thank you. Let's see, we have Hawaii Medical association offering comments as well as two individuals in support. Anyone else wishing to test high on this bill? Seeing none. Members questions.

I have a question.

Yes, Chair Marten, please.

Board of Education. Sorry.

Board of Medical Board.

Yeah, Medical Board.

Sorry, Is this something that is included right now and continuing medical education for people in different specific or do they always like focus on new drugs events possibly sponsored by drug companies that are showing new research on new products.

So thank you for your question. Representative Marten so currently the continuing education requirement in Hawaii for physicians across the board is 100 hours every biennium. Physicians have the ability to choose the CME topics that are relevant to their special needs.

As noted in my testimony, how a primary care physician would view nutrition and metabolic health based issues would be different from say an anesthesiologist or a surgeon or a radiologist who is also under the medical license. Currently Hawaii does not have any specific CME mandates topic specific mandates, but other states have.

Thank you. Thank you Chair.

Okay, thank you.

Representative Takenouchi.

For the Office of the Governor please. Sorry, just quick clarification I guess then is there a reason? Because yeah, the statute. This would be the first thing added to the statute. Is there a reason you guys want to do this?

So this would support our rural health application in our technical score factor that is reanalyzed every year to support funding for the rural health application. So with that intent, we propose this measure to support that.

How much will it impact?

The number isn't. We don't know the number per se, but we hope that with the technical score factor increasing with our state's commitment to our statutory requirements, that it would increase year by year.

Understood. I am a little hesitant because we, I believe this is how that fingerprinting Bill we just heard in this Committee kind of happened where something got added to the statute purely for a purpose like this with a federal application. And now we're kind of in a mess.

So I, I would be a little cautious about this, but thank you for the clarification. Thank you.

Okay, thank you very much. Any other questions from Members?

Chair.

Representative Garcia.

Medical Board, please. Could you briefly summarize your. Your opposition to the bill?

Yes. So our first point is that once a statute, as it has been proved in other states that have implemented specific Cme, specific topic specific Cme, they've added on additional topics. A physician has different areas of practice, such as, as I mentioned before, surgical, primary care, radiology, etc.

Each of these areas have different needs and concerns and would base their. Their practice on these different topics. Their knowledge on these different topics. By mandating specific CME topics for them to cover, it could decrease their ability to receive or to obtain CME in other topics that are more relevant to their area of practice.

So you don't think that nutrition is relevant to primary care or to.

That is not what I'm saying, Representative Garcia. What I mean to say is CMEs are dictated in the industry for each physician's needs. There are currently CMEs available in nutrition and metabolic health. Should a primary care physician feel the need to augment their knowledge in these topics, they have the freedom to choose.

Okay, so if other states have done it, then why the strong opposition? I mean, so you're saying that this would detract from there?

We have said that. We haven't said that other states have adopted specific CMEs on nutrition and metabolic health. We said that they have adopted specific Cmetox. Excuse me. Topic specific CME.

Okay, thank you. Any other questions?

I have a question. Thank you. Is there statistics or data on what kind of physicians are currently doing CMEs on the topic of nutrition and metabolic health?

Currently, the Department does not keep that. I may be able to reach out to a national board and obtain those statistics for you if you'd like.

I think that would be helpful. So if you could, I would appreciate it. And if you could share it with Members of the Committee as well. Thank you. Yeah.

For governor's office. Just following up on my colleague's question and if I understand this correctly, we're putting this or codifying this to help strengthen the rural transformative health care front. What if it doesn't go in?

Are we going to be subject to less funding? So for the strategy that we proposed in doing a Bill like this is just for the time limited that we have to introduce the rural health transformation proposal. This was our way of committing to CMS that we are looking into different options.

But for this application, we have until 2028 to fully implement it. And if we continue discussions on how to get that through in different capacities, that is our end goal. Cool. So this is not our.

This is not the only.

This is not the. The way.

Okay, great. Yeah. Thank you. Thank you, Chair.

Representative Amato followed by Representative Marten.

For the board, please. Could you please explain where physicians receive their additional. Their CME hours every year? Where did. Is there like a online course catalog? How do they receive these trainings?

So basically there's different accredited organizations that hold them on. Sometimes hospitals do medical schools. They're very different providers. There are many different providers.

So it's basically a physician just goes online or something and searches for something of interest to them and that's how they find their specific CME credits.

Also, as outlined in the testimony by the Hawaii Medical association, there are different organizations, such as the hospitals that recruit and obtain these physicians that require certain topics. So we leave that to again, the physician. We defer to the physicians.

That makes sense. Thank you. Thank you, Chair.

For, sorry. It just. It seems so crazy to require a radiologist or, you know, different people that really will never have the opportunity to benefit from this education and take away time from other things. And yet, of course, we want to be supportive of our grants.

In your opinion, do you think that if it was restricted to primary care providers, would that still give you folks the same boost you need?

That's something we would have to look into with CMS. And yeah, that's something we have to look into.

Thank you, Chair.

Garcia, again.

More follow up, Chair, for Dr. Lewin, please. I don't think this would be wearing your SHPDA hat, but maybe just your MD hat. Just curious because I've heard this topic discussed at certain health conferences across the country and trying to. To require this nutrition education requirement for the MD program.

Does the current MD program here in Hawaii or in general require nutrition as part of the education? Because from what I heard, it doesn't. And that's why some states are now trying to require this.

Yeah, I do appreciate. Thank you for the question. I do appreciate that the medical board concern about mandating educational requirements because some states have gone kind of berserk on that to a micromanagement sort of level.

But I think that for when the dean here of Jabsom and I went to medical school back in those days, we got very little nutrition education and it just wasn't part of the curriculum. It needs to be part of the training today.

Obviously it's very important and I think it varies by school, but I think there's been an increase in the amount of education provided. But it certainly is an important topic. Thank you.

Any other questions from Members? If not, thank you all for a very rigorous discussion, which I think we all learned something from. Anyway, let's move on to the next bill, which is House Bill 1597, proposing to establish an Alzheimer's disease research center at the. Uh, and first up, we have. Let's see. Office on Aging on zoom.

Not present on Zoom. Kamal Masaki, University of Hawaii.

Good morning, Committee Members. I'm Dr. Masaki. I'm the chair of the Department of Geriatric Medicine and I'm testifying on behalf of the John A. Burns School of Medicine. I stand on the testimony provided in strong support of this bill and I'll be very happy to answer any questions. Thank you.

Thank you, Doctor. Dr. Jack Lewin, Hawaii State Health Planning and Development Agency.

Good morning, Chair. Vice Chair. Honorable Members, Jack Lewin Ship. We strongly support this bill. We're spending. We estimate we're spending well over $400 million a year on Alzheimer's related health care costs. And we have a very diverse population here in Hawaii that will enable us to attract resources from the Federal Government and other locations.

So we think this would not only pay off to as a benefit to our citizens, but also to the university if it was us. Move forward. So thank you for strong support. Thank you.

Hawaii State Commission on the Status of Women in support.

AARP in support Alzheimer's association of Hawaii Sakayama Vice Chair Lee Loy Members of the Committee. I'm Kobe Chalk with the Alzheimer's Association and we are in strong support of this bill. As Dr. Lewin mentioned, we do have a very unique population, but beyond just the research aspect of this, this will bring more clinical trials here.

Last session, when we passed the resolution to do a feasibility report on this bill or on this concept, there was uncertainty regarding federal funding for Alzheimer's research. However, the research continued through the continuing resolutions. And when the recent health bill was passed out in Congress this past January, Alzheimer's research funding increased by $100 million.

So we're now at $3.9 billion per year annually. Our state gets very little of it, if any at all.

And if we organize our research capacity within the university and really build the capacity that we need to qualify for these federal ADRC grants, which can be 3 million a year renewable every five years, so about 15 million per five year period, that'll bring kind of a base level of funding in addition to any additional grants that the university can apply for for specific research projects.

So thank you again for hearing the bell and thank you on Zoom.

Angela Young.

Aloha, Angela. Melody Young CARES in strong female favor of this legislation. And so, you know, it's very vague where it says in the bill the ethnic and cultural and environmental characteristics study of the dementia.

So if I could propose an amendment to the Committee is if there is more focus or direction in nutrition or like the effects of what causes dementia, I think the Committee can legislate it. So for example, you could focus it on current research developing in high blood pressure and the effects that it has on dementia.

And also perhaps to tailor it more to Hawaii, perhaps an amendment to say how does high poverty rates and native Hawaiian disparities and Pacific Islander like ethnic minorities, how do these people groups get more affected by dementia because of crime and chronic stress? What is the impact of these disparities on mental health and dementia?

For example, nutrition is not a primary healthcare practice in western medicine. And so, so nutrition is not going to be a primary focus in Western medicine because of systemic barriers such as minimal nutritional educational training in medical school.

So if like let's say the Committee were to study nutrition and dementia, I don't think that would be as feasible as studying high blood pressure because research is already developing in high blood pressure and dementia. Thank you.

Thank you. Let's see. We have written testimony, all of in support from about 16 organizations and individuals. So did I miss anyone who wishes to testify on this bill, if not Members? Any questions? Seeing none. Let's move on to the next bill which is House Bill 2159, appropriating funds to the uh, to support healthcare workforce development.

First up, Dr. Sam Shoemaker, University of Hawaii School of Medicine welcome.

Thank you. Chair Takayama, Vice Chair Lee Loy Members, Sam Shoemaker, dean of the Johnny Byrne School of Medicine. We stand on our written testimony and strong support of House Bill 2159 and. Would be happy to answer any questions.

Thank you very much.

Hawaii State Commission on the Status of Women and support. Dr. Jack Lewin SHPDA.

Aloha Chair, Vice Chair Members, we stand in strong support.

NAVI in Hawaii in support.

Hawaii Medical association in support Queen's Health System and support. I have about 1618 organizations and individuals also expressing see all of them in support. So anyone else wishing to testify on HB2159? Seeing none. Members questions? Okay. Seeing none. Let's move on. House Bill 2121 prohibiting the sale distribution of any disposable electronic smoking devices in the state.

And first up, we have Department of Health.

Good morning, Chair and Vice Chair, Members of the Committee speaking on behalf of the Department of Health. So the Department of Health supports HB21 21 draft 1. It does match with our priority to promote health and optimal health, especially for our young people.

And when we talk about health, we're also talking about what happens in the retail market and then what happens in our environment. And what's happened with disposable E-cigarettes is that when FDA banned the sale of the POD based E-cigarettes, remember those when they first came in, they looked like thumb drives.

They actually had cartridges, pods that you could replace. And so in 2020, when FDA banned those, then what happened was disposable products then came on the market and came on with great force. And so what's happened also is that as the prices declined, the nicotine content increased and the cummin, fruit and candy flavors.

And so the other side of that is with the increased content of nicotine, the EPA has moved forward with then taking these E-cigarettes and addressing nicotine as a hazardous waste.

And so that's why we have this issue with the youth bringing this up as a hazardous waste, not just because of the lithium batteries which you should not put into your household trash, but also because of the high nicotine content which is acutely hazardous.

And so the Department of Health really appreciates the fact that the youth have brought this forward and this committee's hearing. HB 2121 House Draft 1. Thank you for the opportunity to provide testimony.

Thank you. On Zoom, the Coalition for Tobacco Free Hawaii Youth Council.

Aloha Vice Chair Lee Loy and Members of the On Health. My name is Maya and I'm speaking on behalf of the Coalition for Tobacco 121, Hawaii is facing a serious youth vaping epidemic. Disposable E cigarettes are especially popular because they are cheap, easy to use and highly addictive.

Many of these products are illegal, yet they remain widely available in our communities. These devices also create major environmental problems. They contain plastic toxic chemicals and lithium ion batteries, and there's no proper way to recycle them. As a result, they end up in our landfills, oceans and beaches.

In 2023 alone, nearly 500,000 disposable vapes were thrown away every day in the United States during our beach cleanups. Our youth council has seen how tobacco waste harms our environment. Many vape parts sink into the sand and ocean where they release toxic substances that threaten our remains serene life. Disposable E cigarettes also pose serious safety risks.

Their batteries can overheat and catch fire when thrown away. Representatives from H Power, Honolulu's energy facility that processes most of Oahu's waste, showed that in 2024, the facility experienced 158 fires and 44 of which were lithium related.

Every disposable E-cigarette contains a lithium ion battery which is not meant to be thrown in the regular trash and can ignite when crushed or damaged in the waste stream. These batteries pose a serious safety risk and they can cause substantial damage with the potential to shut down the entire plant.

And in 2025, multiple incidents involving lithium ion batteries forced H Power to go out of service for days and in some cases, weeks. In certain incidents, operators were unable to extinguish the fires and the fire Department was called. Some youth have also experienced close calls with these devices catching fire.

Another youth council Member shared that he witnessed an exploding vape that his friend was using. It caught fire and as the youth was trying to get it out of his hands, he threw it and a nearby friend was burned on his neck. Disposable E cigarettes harm our health, our environment, and our safety.

Passing HB2121 is an important step towards protecting Hawaii's youth and communities. We respectfully urge you to support this bill. Mahalo for the opportunity to testify.

Thank you. Thank you. Maya. Hawaii Public Health Institute.

Good morning. Aloha Chair. Vice Chair. Members of the Committee on Health, my name is Saya. I am the youth coordinator for the Coalition for Tobacco Free Hawaii, a program with the Hawaii Public Health Institute. Thank you for the opportunity to testify in strong support for HB 2121, which would end the sale of disposition disposable E-cigarettes.

Disposable E-cigarettes are A huge public health problem. The higher nicotine concentrations than previous generations pose a huge concern for nicotine addiction among young people. Previously, as a high school teacher, I saw firsthand the grip of nicotine addiction among the youth I was serving.

And I don't think our students, our teachers, our schools or our communities should have to bear the burden to deal with these harmful products in the schools. Not only is it a public health problem, it's also an environmental problem. When these disposable E-cigarettes are taken apart, there are three main components.

The first being a plastic shell casing which contains non biodegradable plastics. The second thing we also see are the E-juices which contain high, high, high amounts of nicotine and other toxic chemicals. And lastly, we also see the lithium ion batteries that have the ability to explode under high temperatures or high pressures.

As our youth council Members shared in correspondence with H-Power, they shared that there was many fires that were caused from lithium ion batteries. And so the debris from many of the parts of the disposable E-cigarettes raised serious concerns about potential impacts on our water quality and aquatic life.

And due to this, I respectfully urge you to support this bill so we can protect our youth and preserve our environments. Thank you for the opportunity to testify today.

Thank you, Saya, Saya and Maya. And next on Zoom, we have Moira Flannery. Not present, not present. In support. Also on Zoom, let's see Angela Young.

Aloha Committee. Angela Melody Young CARES in strong favor of this legislation.

So electronic nicotine devices should be something that parents and adults consider to restrict access for, to protect students and teens because it contains high levels of nicotine which damages the development of brains and impairs learning and causes long term addictions while also posing severe long term risks of physical and mental health effects like anxiety, depression.

And it impacts brain development, the part responsible for attention, learning, mood and impulse control. And so these products are often marketed specifically for teens. And so, you know, I'm the Chair of the Hui Children and Youth Summit for the last four years.

And this is a topic that many of the students and teens say is something that they're concerned about and want to have peer to peer support. And so I think what this bill does is protects youth and teens by combating the electronic nicotine vape epidemic by restricting access to these devices.

And it is a good lesson to teach teens and youth that you need to stop smoking and learn to express your emotions in a healthy outlet. Make new friends instead of hanging out with bad friends. Because, because vapes can also be associated with gang activity. Thank you.

Thank you. Let's see. Anyone else wishing to testify? Well, first of all, let me note, I have written testimony from 12 organizations and I think 33 or so individuals, all of them in support. So anyone else wishing to testify in House Bill 2121, if not Members? Any questions?

Sorry, Chair, I have a question for DOH.

Hi. Thank you for your testimony and thank you for being here today. I did note that in the department's testimony there is a preference for another bill, which is House Bill 1573, House Draft 1. My question is, does the Department believe that the concerns regarding public health and environmental safety is adequately addressed in that other bill?

The other bill is HB 1573 and it is the bill that was forwarded by the Attorney General's office. That bill actually, yes, would address it and covers more products than disposable products. And so it would be more comprehensive in that way. The other thing is that it would raise it to the Attorney General's level.

And so in terms of enforcement and penalties, they are better defined. At this point. HB2121 does not have penalties and enforcement defined. And so that is still lacking in this bill. 328J is actually the smoking chapter in the Hawai'i Revised Statutes. And so it would fall to an administrative level. Thank you.

Thank you very much for that question.

Just for the record, I just want to note this Committee passed out HB 1573 and if my memory is correct, what it does is it limits the number of vapes that can be sold in Hawaii, but it allows those that are approved by the FBI, FDA to continue to be sold.

That's correct. Only 39 products are currently on that list.

39?

Yep.

Okay. Any other?

Just while you're up there. So among those 39 products, none of them are packaged in disposable.

Believe there is one. And it would come in tobacco or menthol, but it would not be in the fruit and candy flavors.

So this bill would prohibit that one even though it's on the FDA approved list?

Correct.

Maybe prevent future ones. Thank you very much. Thank you.

Okay, thank you very much. If there are no other questions, let's move on to the final Bill on the agenda. HB 1913 was which establishes a Veteran Services Mental Health Coordinator position at the Triple R Army Medical Center. First up, we have Hawaii Office of Veteran Services.

Morning Chair Takayama. Morning Vice Chair Keihokapu- Lee Loy Committee Members John Alamode, Office of Veteran Services. I stand on my Testimony of support with a couple of brief comments. Firstly wanted to thank sincerely the legislators who have introduced and supported support this measure.

The expanse of veteran care and behavioral health is pretty expansive and so navigation in of itself can be discouraging, can be daunting for veterans. So the idea of effective coordination and navigation is essential. The second piece related to that is our veteran service counselors, although they have the counselor name and their title really are non clear clinical.

So as a result there are subject matter experts in navigating the VA system but not necessarily abreast or aware of health needs for veterans. So concurrently in the military side I'm also the behavioral officer for the Hawaii Army National Guard. So we know very well how the stigma and access to care for behavioral health is critical.

And so thusly coordination navigation often is an undervalued expertise in the area and that's why this particular position is quite viable. So mahalo for the opportunity to testify. Thank you very much.

Let's see. On Zoom Oahu Region HHSC Sean Sonata.

Good morning Chair, Vice Chair Committee Members Sean Sonata on behalf of the Oahu Region, we support this measure. We think this is an important resource for our veterans and we would stand otherwise on our written testimony. I'll be available for any questions.

Thank you.

Thank you.

Colonel Thomas Driscoll.

Chair Vice Chair Members Tommy Driscoll, Colonel, US Army Medical Service Corps, retired, testifying as an individual in support of this bill. Stand on my testimony. Stand ready to address questions if you have any. Thank you.

On Zoom Angela Young.

Aloha Angela Melody Young. CARES I'm in favor of this legislation and I think what this legislation does is it improves mental health care for veterans so that we can honor those who have served and are in active duty and have fought for our country's freedom by providing access to healthcare through a dedicated staff position.

And this will help facilitate the healthcare process and promote continuity of care during transitions and provide a direct point of contact for veterans and their families.

Thank you very much. Let's see, we have written testimony from the Veterans Caucus of the Democratic Party employee in support as well as five individuals all in support. So Members, any questions?

Representative Garcia.

Thank you. Chair for the Office of Veteran Services, please. Thank you for being here. Thank you for your service and what you folks do. My question is does Tripler Army Medical center currently have any state funded positions that we pay for located at Tripler currently.

So currently. Thank you for the question. Representative.

The Hawaii Office of Veterans Services is located and the E an et cetera. So we actually Enjoy the benefit via the va. So it's in the VA wing of the triple Army Medical Center. So our tripler staff at OBS is there, which is where I'm located. And we also have staff on Oahu at the apoca.

CBOC in Okay, C. Folks work closely with the VA. Does the VA have a mental health clinic coordinator position currently? So they may not carry that title per se, but certainly they may have a title, for example, of intensive case management, as an example. So case management, care coordination is often a common profession within behavioral health.

So within the VA system, we have navigators to access services within the VA system itself, as well as a community care program.

Thank you. Thank you very much. Any other questions for Members? If not, let's move on to decision making. Okay, Members, if you're ready, let's start with the first bill on the agenda, which is House Bill 1864 relating to ensuring standard fertility preservation services.

I'd like to move this forward as a House draft, making it clear that the intention of the measure is to include dependents over the age of 26.

So accordingly, make a couple wording changes on page one, lines seven and eight, to say, quote, provide to the policyholder or any dependent of the policyholder who is covered by the policy, end quote. And page four, line five.

Similarly, quote, provide to the subscriber or Member of any dependent of the subscriber or Member who is covered by the plan contract. Secondly, remove reference to the 2018 guidelines of the American Society of Clinical Oncology and substitute instead of the date, substitute the words most current guidelines of the ACO.

Thirdly, on page three, lines 18 and 19, add for consistency, add sperm retrieval to the list of procedures not complicated. Fourth, on page five, line three, add for clarity, quote, except as provided for in subsection B in quote. And finally, add a defective date as well as any as any necessary technical amendments. Members.

Any questions or comments or concerns? Seeing none. Vice Chair for the vote.

Thank you, Chair. Members voting on House House Bill 1864. Chair's recommendation is to pass with amendments. [Roll Call]

Reservations?

Thank you, Chair. Your recommendation is adopted.

Thank you. The next bill is HB 23045 relating to continuing medical education. Thank you for the very vigorous discussion. I'd like to move this bill forward as a House draft to keep the discussion alive, adding while providing a defective date, also technical amendments.

Also noting the report language that both The Hawaii Medical Association Hawaii Medical Board raised concerns about putting this requirement in the statute. So with that, Members, any questions, comments or concerns? Not Vice Chair for the vote.

Thank you, Chair. Members voting on House Bill 2305, Chairs recommendation is to pass with amendments noting the excused absence of Mr. Olds representative Olds. Any Members with reservation, Reservations? [Roll Call] Any others voting? Any Members voting? No. Thank you, Chair. Your recommendation is adopted.

Thank you, Members. Just a note that it does go on to CPC Committee for further discussion. HB5097, Alzheimer's disease resistance Research. I'd like to pass this bill forward as is. Questions, comments, concerns?

Thank you, Chair. Members House Bill 1597. Chair's recommendation is to pass as is, noting the absence of Representative Olds. Any Members with reservations. Any Members voting? No, Chair, your recommendation is adopted.

Thank you. HB 2159, Health Care Care Workforce Development. Like to move this forward as House draft with technical amendments for consistency, clarity and stuff. Members questions, comments, concerns? If not Vice Chair.

Thank you, Chair. Members House Bill 2159, House Draft 1. Chair's recommendation to pass with amendments noting the absence of Member Olds. Any Members with reservations. Any Members voting? No, Chair, your recommendation is adopted.

Thank you. Hospital 2121 relating to electronic e-cigarettes. Like to pass this forward as it's. Questions? Comments? If not.

Sorry, Chair, just, just a comment that I. I found the Department of Health's testimony persuasive, but I will still be putting. I.

Yes, I also have a comment inspired by that comment. I think that, you know, they're quite different. One is targeting matching federal standards that are approved by the FDA so that they're consistent with smoking cessation goals.

So that's about the product itself, whereas this is about the packaging and we don't know if the other one will pass and we don't know if packaging in the future will start to become more disposable for FDA approved products. So I think it's great to have both.

Any other comments? If not Vice Chair Flu.

Thank you, Chair. Members House Bill 2121, House Track 1. Chair's recommendation is to pass as is noting. Member or excuse. Any Members with reservation, reservations? Thank you, Mr. Garcia. Any Members voting? No, Chair, your recommendation is adopted.

Thank you. The final bill, House Bill 1913 veteran met veteran Mental Health Services. Like to pass this forward as is. Questions? Comments? Vice Chair for the.

Thank you, Chair. Members House Bill 1913, House Draft 1. Chair's recommendation is to pass as is noting the absence of Mr. Olds. Any Members with reservations, any voting no? Chair your recommendation is adopted.

Thank you, Members. That's it.