House Standing Committee on Finance

Aloha. We are convening the Committee on Finance for our 10am agenda. It's Friday, February 272026. We're in Conference Room 308 live in person and on Zoom. Some quick refreshers. If you are on Zoom, please stay muted until you're called upon. And we do stick to a two minute time limit per testify.

We'll give a little bit of flexibility should you be extremely compelling, you know, that kind of thing.

But otherwise, if you, if you can for the most part stand on your testimony unless there's something really critical you need to explain, or if you are going to testify and you have provided written testimony, please try your best to just summarize or provide additional context instead of reading it directly.

But other than that, I think we're good to go. We can get started. We're going to open up with HB816 HD1 relating to emergency response.

First up we have the Department of Health with comments.

Good morning, Chair, vice chair, Committee Members, Garrett Hall, Chief of Emergency Medical Services and Injury Prevention for the Department of Health. We stand on our written testimony and here to answer any questions you may have.

Thank you. We have Kylie Swan in support on Zoom. Not present. That's everyone who indicated they would be joining us, Members. Also testimony and support from Council Member Kagiwata from the Hawaii County Council and two other individuals.

Okay, Members, any questions on this measure? Seeing none, we're going to move on to HB 1535 HD1 related relating to automated external defibrillators.

We have the Department of Health with comments.

Good morning, Chair, vice chair, Committee Members, Garrrett Hall, Chief of EMS at the Department of Health. We stand on our written testimony as submitted in here to answer any questions.

Thank you. Department of Taxation with comments.

Good morning.

Thank you. Tax foundation of Hawaii with comments on zoom.

Good morning, Chair, Vice Chair, Members of the Committee, Tom Yamachika for Tax Foundation. For the reasons stated in our testimony, we think it's a lot more efficient for this to be handled outside the tax system. We have subsidy programs such as High Energy.

This could be handled, you know, much similarly to that with I think a greater impact and more accountability. Have to answer any questions. Thank you very much.

Thank you. If we have Kylie Swan and support on Zoom still not present, that's everyone indicating they'd be joining us. Also support from one organization and one individual. zero, is there anybody else in the room wishing to testify? Anybody on Zoom?

Okay, Members, any questions on this measure? Seeing none. We're going to move on to the next item, HB 1537 HD1 relating to mental health.

Department of Health and support.

Good morning, Chair, Vice Chair and Committee Members. My name is Kaylee Okuaro. I'm the administrator for the Child and Adolescent Mental Health Division. We stand in our written testimony in support of this measure and I'm available to answer any questions. Thank you.

Thank you. We have the Hawaii State LGBTQ Commission in support on Zoom.

Good. Good morning. Happy aloha Friday. Michael Golojuch Jr. Vice Chair of the Hawaii State LGBTQ+ Commission. He him pronouns. We stand in strong support of this measure. You have our testimony in front of you. The couple things we do want you to know.

Earlier this year, the Lemke Institute, which tracks genocides around the world, issued a warning that the United States is in the early stages of a genocide for the transgender community. What is it?

Since the attacks on Mahu, transgender non conforming communities have began last year, we have seen the suicide rates quadruple for this community just in the last eight months, bringing it close to home.

In the last this year alone that we've lost three keiki that we know of, the need for access to mental health care is now, well, years ago, but the now is now more than ever.

As already as you have in our testimony, you heard from others, we know you're probably not going to amend this Bill to include the protected classes that we requested in our testimony.

But we do request, if you, if you won't do that, that you at least include the list of protected classes found in our testimony in the Committee report.

So when this program hopefully goes forward and gets funded, that the those charge of the program know that they definitely need to take special consideration for these classes to end the special needs. So we encourage you to pass this Bill. We hope you amend it, but if not, put it in the Committee report.

So moving forward, thank you and we available for any questions. Mahalo.

Thank you Hawaii Substance Abuse Coalition and support.

Good morning, Chair, Vice Chair, distinguished Members, I'm Alan Johnson with the Hawaii Substance Abuse Coalition. We now see that mental health diagnosable anxiety and depression is just out of sight, up to 40%. It's just unbelievable what's happening in schools.

And as providers with boots on the ground, we know that because we have substance abuse programs in the schools, the high schools and middle schools, and we see that many of them are coping by using substance abuse, alcohol and tobacco. And the issue is that we have this robust substance abuse program in schools and high schools.

There is no mental health program, preventive program in the schools that will deal with families and kids. And the science is there. Providers and subs abuse have evolved in the last 10 years. We now do substance and severely mentally ill for adults and kids. We and subsequent can deal with the alcohol and mental health in one setting.

We have the expertise, but here we're operating silos with no funding for mental health. We're saying this is an opportunity to evolve our state systems. We're in the schools. We've got relationships with the teachers, the kids, and the school counselors. It's the most economical way ever possible to begin for this state.

The science is there to say it's time to evolve mental health, substance abuse, together at one time, we could make a huge difference. We appreciate the opportunity to testify today and, and thank you for your time.

Thank you. We have Hina Mauka in support on Zoom.

Aloha Chair Todd, Vice Chair and Members of the Committee. As we have heard here today, what we are really missing is a coordinated approach between mental health and substance abuse prevention. Adolescence is such a critical window of development when young people experience intense emotional change, social pressure, and brain development. And.

And that's also when anxiety, depression, trauma, and other mental health challenges often first appear. What we need to do is be treating those together. We cannot treat them separately because just as adults, adolescents turn to alcohol, vaping and substances to try to calm their nerves and escape emotional pain.

So it's very important to treat all of these challenges at the same time. HB1537 allows us to integrate that prevention as expressed by other testifiers. We appreciate your time and we thank you for the opportunity to testify.

Thank you. We have Catherine Abellera in support on Zoom.

Aloha. Good morning. Thank you. Chair. Vice Chair Committee Members. My name is Catherine Abellera and I stand strongly in support of this field. And I am a mother of a daughter who lost with death by suicide. Sorry. I just want to show you that my daughter was 28 years old. She was a PhD student at UMass.

But these things didn't start as an adult. They started early on, probably middle school, high school. And there's really limited access to resources. And I think if we have more preventative and more accessible services, I think a lot of this could be addressed early, caught early. And I really, I really hope that you.

That you pass this field. And I am strongly supportive. Thank you for letting me be here.

Thank you. We have Myah Pupilis and support on Zoom.

Oh, hi. Aloha Chair, Vice Chair and Members of the Committee. My name is Myah Pupilis and I'm a student at Kalaheo High School and I'm in strong support of HB1577. As someone who has firsthand, we experienced high schools and middle schools in Hawaii. Our youth is in a mental health crisis.

Over a quarter of middle schoolers have considered suicide. And I have dealt with my peers dealing with those thoughts and I've even had one commit suicide. And I don't think we can afford to wait for a total breakdown of these issues before we offer them any help.

And I think this Bill focuses on the window of ages 10 to 19 and community based early intervention. And I think that addressing the trauma before it turns into substance abuse or long term disabilities is something we need to focus on. And I think this is a proactive investment for Hawaii's future. And please pass HB 1537.

Mahalo for the opportunity to testify.

Thank you. That's everybody who indicated they would be joining us today. Also testimony and support from the State Council on Mental Health, three organizations and five individuals. Is there anybody else in the room wishing to testify? Fine. Anybody on Zoom?

Members, any questions on this measure?

Chair for Department of health, we have Dr. Okuaro.

Yes. Hello.

Hi. Thank you. I just wanted to make sure that we're all on the same page in terms of adolescence. Like, could you let us know exactly what ages that will cover should this bill pass?

Sure. So the Child and Adolescent Mental Health Division, we serve really ages 3 through 21 and except for our first episode psychosis program, which goes through age 24. But we are working closely with our partners who also serve adolescents.

Department of Education, Alcohol and Drug Abuse Division, Family Health Services Division, Office of Youth Services, Injury Prevention Branch, which is the seat of our suicide prevention activities. So it would be in that age range. But I'm proposing a coordinated, or, you know, through 21. And I'm proposing a coordinated approach across the different child serving agencies.

Several people have noted that the system, while I think we provide a lot to support adolescents, it can be sometimes siloed or fragmented because of the way it's organized. So across those adolescent serving agencies, I think we would want to come together to agree on the most impactful programming for adolescents.

I'm sorry. So to clarify, if passed as is, this Bill could cover ages 3 to 21. However, the Department would work with the community agencies to determine what ages would fit into the adolescent needs. Did I get that correct?

Yeah. So when we, when we. Yes, sorry, I know it's. I wasn't very clear. So when we go through the competitive procurement process.

As we start to define scope for community programming, when we do our requests for information, oftentimes we'll learn from the providers who are providing services, you know, what age ranges should be targeted for specific services, for example.

So I think if we do get an appropriation to provide community based preventive services, we're going to listen to the provider agencies through that RFI process to build scope that's kind of targeted and impactful for the age range that those services are built for.

So without having gone through, through that process, I don't want to say, you know, that we're going to include or exclude any particular group of adolescents. I think what we'll learn through the competitive procurement process is how to tailor services as effectively as possible.

Thank you so much. That was very helpful. Thank you. Thank you.

Members, any additional questions? Seeing none, we're going to move on to HB 1541 HD2 relating to the Department of Health.

We have the Department of Health in support. Thank you. And HGA in opposition.

HGA will stand on its testimony in opposition. Thank you.

That's everyone. That's all the testimony we've received on this measure. Anybody else in the room wishing to testify? Anybody on Zoom?

Additional questions on this measure? Seeing none, we're going to move on to HB 1562 HD1 relating to youth

Mental health, Department of Health and support on zoom.

Good morning, Chair, Vice Chair and Committee Members. I'm Kaylee Okoro. I'm the administrator for the Child and Adolescent Mental Health Division testifying in support on behalf of the Department of Health. We stand on our written testimony and I'm available for questions. Thank you.

I have the Hawaii State LGBTQ+ Commission and support on Zoom.

Aloha again, Michael Golojouch, Jr. Vice Chair of the Hawaii State LGBTQ+ Commission. He him pronouns we stand in strong support of this measure. Like I said earlier, access to mental health is long overdue for our especially. We need to destigmatize it. We need to be able to meet the kids where they're at and it's online.

This would be a great way. We know it's a pilot project, but if our community is left out at the inception, we tend to be forgotten when it comes to talking about Mahu LGBQI plus Cutie Pie community.

We again, we, we realize you probably will not amend this, this bill to it specifically include our community in this, but we do hope you will continue the practice that was started in the previous Committee by listing it in the community Committee report to ensure that when this project is being, if this project should come to fruition, which we hope it does, that we are part of the DNA of this program and so that we are woven into it to making sure that the needs of our community and other minority communities are served because we all, they each have different needs and they need to be looked at it from a different perspective and lens.

So we encourage you to pass this bill. We encourage you to make this happen. And we look forward to this no longer being a pilot project in, in the near future, but a permanent part part of this program. So thank you and available for questions. Mahalo.

Thank you. Hawaii Public Health Institute and support.

Morning Chair and vice chair and Committee Members. I'm Chris Caulfield with the Hawaii Public Health Institute. We're in support of this measure because mental health is essential to public health.

And just to put some data behind the amazing testimony that you've heard today, there one in three public school students in grades six to 12 are facing mental health challenges. Yet less than 25% of those are able to receive care, a number that drops to less than 20% just for high school students.

And there's research that shows that 26% over 26% of students in grades six to eight have seriously considered attempting suicide. Youth or digital natives. This is going to be a digital platform. So we think this makes sense.

We just wanted to note that in some states like Louisiana and Washington, there's already efforts being made around programs like this to ensure that Medicaid programs can provide coverage determination processes to make sure that digital mental health tools are fully incorporated. So we think this is a great idea. We'd love to see it before.

Thank you so much.

Thank you. That's everybody who indicated they would be joining us. Also testimony with comments from the State Procurement office and one organization, as well as support from the State Council on Mental Health, five organizations and two individuals. Is there anybody else in the room wishing to testify?

Anybody on Zoom?

Members, any questions on this measure? Seeing none. We're going to move on to HB 1574 relating to the Healthcare Education Loan Repayment program.

We have the University of Hawaii in support on Zoom. Oh, in person, actually.

Hi, Kelly with the University of Hawaii. I stand on my our testimony and strong support.

Thank you. State Health Planning and Development Agency SHPDA in support.

We stand on our testimony. Chair, Vice Chair and Members, Jack Lewin. And we, we think this has been an extremely successful program. Nearly a thousand participants like to see it continue. It's very important. Thank you.

Thank you. We have Navient Hawaii in support. The Hawaii Affiliate of the American College of Nurse Midwives and support on Zoom.

Aloha. My name is Margaret Reagan. I'm the legislative contact for the Hawaii Affiliate of the American College of Nurse Midwives. We stand on our testimony. I would like to additionally discuss the practice environment for graduates for midwifery graduates. We appreciate the fact that midwives have been named as potential recipients of these loan opportunities post graduation.

In Hawaii there are no residency programs for fellows. There are such programs for nurses. There are such programs for MDs. But for the Hawaii graduates there is not an opportunity to go from school directly into a full scope practice. Hospitals do not hire in Hawaii recent graduates. This is a barrier.

I don't know how it can be addressed through an amendment, but I do want to bring it into to the attention of all who are involved in this loan project because it's a wonderful opportunity and we do have a chronic provider shortage and midwives could be a part of the solution.

They are on all islands and working in all environments. The other barrier though proposed that could be addressed is the requirement of a 30% clientele that is receiving public insurance. That has not been addressed in, in this Bill.

There are a number of private practice midwives across the state who provide care, but for a number of reasons they are not providing it to 30%. So recent graduates potentially could be employed with one of these private practices or even larger institutions such as Kaiser do not accept Medicaid.

So though there may be jobs available, it would prohibit these midwives. We hope you will consider and I'm available for any questions. The final comment, I guess I would say is the fiscal implication of including these midwives is small. We're talking about a few very key providers who potentially are from Hawaii who could stay serve their communities.

So I, I genuinely hope you'll consider this recommendation. Thank you.

We have Ohia Midwifery and Wellness and support on Zoom.

So I have to be careful. Sorry, one moment. My name is Margaret Reagan. I have to be careful because I wear a number of different hats.

I testify on behalf of a private practice, Ohia Midwifery and Wellness, and as the founder of what will hopefully be the first nonprofit licensed freestanding birthing facility on the island of Hawaii, Lehua Community Birth Center.

I am speaking on behalf of all three credentials of midwives as they will all be employed and I currently contract with all three credentials through my private practice at Ohia Midwifery and Wellness.

I stand by our written testimony and the only part that I would like to reiterate is that There are currently 21 locations that are employing APRN CNM's. None of these locations yet are available to of the institutions are available to employ CM LMS as they needed to.

They need to be added to bylaws, but we are actively working on that. A number of these sites potentially could hire Hawaii based students, but it's all in process and it will take years. The CPMs that are working across the state are generally all in private practice and I contract with some of them.

No one is currently able to take Medicaid though the majority of them are capable of hiring a new grad. And so we really hope that you will consider the benefit of some kind of an adjustment to the 30% public insurance requirement of the loan.

I don't know how that could be addressed in this Bill, but I did try to reach out to the Chair to discuss prior to hearing. Thank you for considering our suggestion. Mahalo.

Thank you. That's everyone who indicated they'd be joining us. Also testimony and support from the Office of the Governor, the Office of Hawaiian Affairs and nine other organizations. Is there anybody else in the room wishing to testify? Anybody on Zoom?

Members questions on this measure? Seeing none. We're going to move on to HB 1591 HD1 relating to health care.

We have the University of Hawaii in support on Zoom.

Oh, University of Hawaii stand on support. But I think Laura Reichardt was maybe going to testify.

Oh, we're all supported.

Department of Taxation with comments.

DOTAX stands on our written comments.

Thank you, DCCA Board of Nursing and support. Thank you. Hawaii State Commission on the Status of Women in support.

Yes, good morning everyone. I stand on my written testimony and support. Thank you for your consideration.

Thank you Hawaii Public Health Institute and support.

Chris Caulfield from the Hawaii Public Health Institute. We're very much in support of this measure as well. As you're all very well aware, there's a massive doctor shortage in the state of Hawaii that's grown to over 800 positions.

And on Hawaii island, which is the most acute you have, Hawaii island has to would have to grow its position supply by 43% to meet demand. Maui's just behind that at 35%. And this program, when it was originally evaluated showed that There was a 77% increase in active preceptors, which is phenomenal in terms of its effectiveness.

We're particularly interested in this because it includes social workers and we talk about the doctor shortage and medical professional shortage a lot.

We don't often talk about social workers as much but there was a report that came out from UH's Thompson School of Social Work that showed the demand for healthcare social workers in Hawaii is going to grow by 18% over the next decade, and for specifically, mental health and substance abuse social workers by 22%, which is a big need in our population as well, and one that we often work with at hifi.

So we're in strong support of this, and we we are hopeful that it moves forward this year. Thank you so much.

Thank you. We have Tax foundation of Hawaii with comments on Zoom.

Thank you, Chair, Vice Chair, Members of the Committee, Tom Yamachika from Tax Foundation. We had some very short comments, and we'll stand on those, and we'll be happy to answer any questions.

Thank you. Hawaii Academy of PAs and Support on Zoom.

Hi, good morning. We stand on our testimony. We'd like to add that the importance of the preceptor tax credit is ultimately to support healthcare workforce development.

Today PAs have not been included in this preceptor tax credit, but we now have PA students from Hawaii who are attending Hawaii based institutions for PA school and it's important that we support these students so that they can have clinical education experiences in Hawaii and ultimately stay in Hawaii.

Thank you. Kaiser Permanente in support, present. Ohia Midwifery and Ohia Midwifery and the Wellness and Lehua Community Birth Center in support on Zoom.

Aloha. Thank you for this opportunity to testify. I speak on behalf of a private practice and developing birth center. We stand by our testimony.

I want to reiterate that the benefit of consideration of the addition of a clause that has been utilized in SB2491, the landmark Bill that revised statutes regarding health care to use provider neutral language where applicable. We just as the previous testifier for PAs, we wish that midwives could be included.

There was a clause in that massive bill which was midwives license under Chapter 457j. We wish to be included in this opportunity. Even then, we also want to reiterate that there is no midwifery based program in Hawaii. Though There are currently 70 plus midwives serving the community and a number of them available to precept.

All of their students are in remote programs. None of those programs have a 50% Hawaii student base. These programs are very familiar with the medical community.

They include Frontier Nursing and Georgetown University, Thomas Jefferson University and there is a new program starting through the University of Colorado Anschutz that has incredible rural health scholarship programs for both certified nurse midwives and certified midwives who are dedicated to serving their communities. Last year we asked for consideration of this barrier for midwifery preceptors.

It's very difficult for Hawaii based students, number one to enroll in a rural program and then number two to secure a clinical site. The clinical sites currently are Kaiser, Tripler and Queensland. During the government shutdown I was directly in touch with students at Tripler where their ability.

They've been trying to finish their program for years and their clinical experience kept getting interrupted by the shutdown. This student had tried to secure a place in Kaiser, had tried to secure a place in Queens. On any island there are three private practice midwifery groups that also precept students.

So we very much hope that you will consider it. This is very much a social justice issue for the APRN. CNMs and the CMS in Hawaii, there is only one Native Hawaiian provider. And for the CPMs, LMS, that of the 40 licensed providers, there is only one who was born and raised in Hawaii. So.

So we really hope that somehow we can address the need to grow providers from Hawaii and to support them. It's wonderful that this preceptor program is going. It seems to be very effective. I think it's important to understand that the two credentials of the aprn, CNM and the CMLM are advanced practice credentials.

They both act as primary care providers, so already they were in alignment with the first initiative. And it's wonderful that there's consideration of other credentials. Thank you so much.

Thank you. Thank you. Members. That's everybody who indicated they'll be joining us today. Additional testimony from 18 organizations and 16 individuals. Anybody else in the room wishing to testify?

Hi. I'm sorry, I wanted to testify as an individual outside of the, UH testimony. You guys are brilliant. To start the preceptor tax credit.

I'm sorry, can you just state your name for the record.

Sorry, Hollywood.

You guys are brilliant. Starting the preceptor tax credit program five years ago, we've only used half the funds allocated and less every year. And while I'm a physician and I do the physician workforce research, only physicians, nurse practitioners and pharmacists can actually make use of this. And as you've heard, we now have way more programs.

We have occupational therapy, physical therapy. We have two PA programs we're just developing wonderfully in the state. And now we have some rural health transformation money that will pay tuition for these programs and it'll pay for the travel to do work, rural training. So I really encourage you.

It's a cheap way to get these trainings done because it'll only cost. The money's already in there. You know, if we could maximize the preceptor tax credits, I think it would go a long way to training our healthcare teams together like we need to do. Thanks.

Thanks. Thank you. Anybody else in the room? Anybody on Zoom?

Members, any questions on this measure? Seeing none, we're going to move on to HB 1853 relating to dementia.

We have the State Health Planning and Development Agency, SHPDA, in support.

Hi, Jack Lewin, SHPDA Administrator. Thank you Chair, Vice Chair, Members. We stand on our testimony in support.

Thank you. Executive Office on Aging with comments.

Morning Chair, Vice Chair, Members of the Committee. My name is Caroline Cadirao. I'm the Director of the Executive Office on Aging and we support the intent of this bill and wanted to offer some comments. This bill requires the Executive Office on Aging to establish and operate the HANAI Memory Network.

That will include hiring the project manager, the Dementia Care Specialists, coordinate services, create the clinical partnerships, provide training, collect data, and to report back annually to the state Legislature. EOA is currently leading the Hawaii Dementia Initiative, which we've done a lot of good work around.

We have delivered statewide dementia education training, over 6,300 community members and 2,600 professionals. Our public awareness campaign, that just wrapped up in December, reached over 56 million impressions and we launched the Healthy Brain Tracker.

And we also are trying to fulfill the Mandate of Act 286 from last legislative session, which requires us to collect data on early initiatives around dementia. And despite all of these accomplishments, we're currently at capacity.

I have a lot of staff vacancies and despite all of this, we just ask that either we are allowed additional time to implement this project or looking at a time when both our infrastructure and the state's economy is in a better position to launch this project. But on a personal note, my dad had dementia.

He since passed, a few months ago. My mom just started adult daycare this past week because she has dementia also. So this is personal too, but just wanting to take it off my director's hat and just saying this is a good project. Just maybe the timing and I'm available for any questions. Thank you.

Thank you. Alzheimer's Association Hawaii in Support.

Hello Chair Todd, Vice Chair Takenouchi, Members of the Committee. I'm Coby Chock with the Alzheimer's Association and we're in strong support of this bill. This bill is a cost saving measure. The Alzheimer's Association has been fighting for decades against this disease and the state has too, but we've been fighting it on the back end as a state.

As of 2020, the annual spend on Medicaid for people living with Alzheimer's and dementia was about $240 million a year. As of 2025, the number was up to $309 million per year. So it's a $69 million increase and we're expecting that number to double over the next 25 years.

At this pace, our state's going to be paying nearly a billion dollars in Medicaid costs for people living with Alzheimer's disease, if we don't do anything. New treatments and advancements in medicine now allow earlier detection and very excitingly treatment. These treatments slow down the progression of the disease significantly.

But aside from just slowing down the disease, creating a care plan also benefits both people's pockets, as well as, their ability to work and support their families. The measure that you have would establish a memory clinic on the neighbor islands where support is needed the most.

When someone is diagnosed with the disease, they need to make it to a specialist. About 40% of PCPs weren't trained on dementia care, and about 60% weren't trained on or aren't comfortable making a diagnosis. So it's important that people have access to specialty care to receive these treatments so that this is equitable for the entire state.

We kindly ask for your support in moving this bill forward so that we can continue to help people in the state access treatment earlier and bring the cost of this disease down. Thank you.

Thank you. That's everybody who indicated they'd be joining us. Also testimony and support from the Disability and Communication Access Board, four organizations and 18 individuals. Anybody else in the room wishing to testify? Anybody care? Yes. Yeah. Just state your name and stand for the record and you can proceed.

Good morning, Chair, Vice Chair, this Committee Member. This is Kaili Swan. I'm in written. I mean, strong written testimony support this bill. And please leave me a quick if you want to testify. Sorry for being late, Chair.

Anybody else on Zoom?

Okay, Members, any questions on this measure? Seeing them Moving on to HB 1854, HD1 related to community behavioral health clinics.

We have SHPDA in support, Not present, and HGA in opposition.

HGA stands on its testimony in opposition. It's just limited to the civil service language. Thank you.

Thank you, Members. Also testimony. That's a run to indicate they'd be joining us. Also testimony and support from the Hawaii State Council on Mental Health. Is there anybody else in the room wishing to testify?

Members, any questions?

I thought we are. Did you not receive our written testimony? DOH in support. 1854.

Sorry, I skipped. Oh, I read it wrong. Sorry. Yes, it is you guys. Thank you. Okay. Yeah. Anybody else in the room wishing to testify? Anybody on Zoom?

Thank you. Members, any questions? No. We're going to move on to HB 1871 HD1 relating to health Department of Health with comments.

Thank you. Hawaii Commission on the Status of Women in support.

Yes. Maintaining. For the Commission on the Status of Women. We stand on our written testimony in support of this measure and appreciate the committee's consideration. Thank you very much.

The Hawaii Affiliate of the American College of Nurse Midwives and support on Zoom.

Aloha. My name is Margaret Reagan. I am the Hawaii Affiliate of the American College of Nurse Midwives. Legislative contact. We stand in strong support of the intent of this bill.

We stand by our testimony and Want to reiterate when we when the state is considering a pilot project regarding prenatal and postpartum care, we would hope the state would consider including midwives in the that project. So please consider naming the from the affiliate we represent APRN CNM's SO Advanced Practice registered nurse, certified nurse midwives.

And the other credential is a certified midwife licensed midwife. They are advanced credentials and additionally there is another credential of a midwife that could be engaged. It makes very good sense. We are regularly dealing with seeing clients with hypertension and diabetes or gestational diabetes. We do follow up. It makes complete sense to include us.

So please consider including us within the healthcare provider definition and the remote monitoring clinical care team. Mahalo for your time. Suggested amendments have been provided in our written testimony.

Okay, thank you. That's everyone indicating they'd be joining us. Also testimony and support from another one other organization and one individual. Anybody else in the room wishing to testify?

Hi, I'm Brian Vic here on behalf of Acting Executive Director Christine Pagano and the Disability Education Access Board. We are in support of this bill. Know that these can have an impact also not only on the bombs, but also potentially on the children. So we would urge you to pass this. Thank you.

Thank you. Anybody else in the room? Anybody on Zoom.

Chair? This is. I stand on testimony support.

Thank you. Anybody else on Zoom

Members, any questions? HB 1965 HD1 relating to primary care.

We have SHPDA in support.

Good morning, Chair Todd, Vice Chair Takenouchi and honorable membership. SHPDA did not propose this bill. It's companion bill 292690 was identical. It proposes to increase financing for primary care in Hawaii. And I feel the need to discuss the comments.

We didn't propose it, but hundreds of Clinicians, jabs and faculty members, health centers and patients reported the need for us to put some attention on primary care in this state. We're sad that the original purpose of the bill didn't proceed.

It was to expand the funding from what we estimate right now is 3 to 4% for a lot of insurance. And there's so much misinformation about how much we're investing in primary care. We're calling primary care urgent care clinics, which are not continuity of care. We're calling primary care a bunch of other things, contracts and so forth.

We're really not spending enough money here. The Federal Government that offered the AHEAD grant to this state specifically said we need to increase primary care funding in our state from their data to at least 12% over the course of the AHEAD grant. So there's just a lot of misinformation. Insurance companies have different views of what they're spending.

Some are doing better than others. But this is really important because we got to think about this in terms of just the rest of the world and, and our country. If we look at the OECD nations in the world, there's 38 of them. We're the only one that has. We're spending 17% of our GDP.

The rest of these 37 are paying 7% on average. We have poorer health outcomes than all the other 37 nations. They have greater longevity, better cancer, better heart disease outcomes. And so we've got to look at what's the cause.

And a lot of it really is just the absence of primary care to screen the early parts of, of, you know, illness. In the beginning. I don't want to go on too long about this, but I think that in this Bill we kind of pushed away the original intent to get up to 12% over years.

And we have a working group which is really saddening, I think to the people that proposed this. We'll make that working group dynamic. We'll come back with data next year. We're asking only for $100,000 though to help us because we're going to need some data acquisition and a part time person to help us with that.

And we really think that this will make a big difference in not only improving population health in Hawaii, but actually reducing health care costs over the long run significantly. So thank you for hearing the bill and we'll be back next year. Thank you.

Thank you. Hawaii Association of Health Plans with comments.

Chair, Vice Chair, Members of the Committee, Rachel Wilkinson on behalf of the Hawaii Association of Health Centers and, and on our written testimony providing confidence.

Thank you. HMSA in support.

Good morning, Chair, Vice Chair, Members of the Committee. I'm Moani Rayben, also with HMSA. We're here in support today of House Bill 1965. This is a very important issue and yet very complex.

And so we very much so appreciate the previous committee's approach to establishing a primary care working group which ensures that all stakeholders are together at the table with a voice to have a better collaboration and to provide a meaningful recommendation next year. Thank you very much.

Thank you. Hawaii Healthcare Task Force in support.

Good morning. This is Scott Grosskreutz. I'm a breast cancer specialist and President of the Hawaii Healthcare Task Force. I'd like to thank the Committee for hearing this bill. Many of the healthcare heroes who provided primary care during the Covid pandemic are now on the verge of fiscal insolvency.

Only about 3.6% of Hawaii's health care funding from CMS is being used to pay primary care providers who provide about 80% of the health care visits in Hawaii. This is extraordinarily shortsighted as adequately funding primary care with lower global health care costs and improved patient outcomes.

Our research shows that the Hawaii insurance companies are spending about $100 million annually on third party contractors who are mostly on the mainland and provide no patient care. There are many states that are passing laws enforcing regulatory targets or issuing Executive orders to force insurance companies to adequately Fund primary care.

It would be pono for all Hawaii insurance companies to publicly pledge to Fund primary care at 6% by January 2027. And the Hawaii health care task force calls upon our insurance industry to do so. It's illogical for insurance companies to argue that this cannot be done in Hawaii.

It's already happening in many other states today in the entire continent of Europe. Another major regulatory challenge that we have is that there are six state laws and three federal laws that require DHS to report key performance indicators such as primary care spending.

But when the task force requested report 601 which documents primary care spending from DHS, there was no primary care spending report. It was a blank report. How can Hawaii enforce adequate funding to primary care unless we keep track of it?

And thus I echo Dr. Lewin's request to get some adequate funding for ship to carry on this important research. We ask that the Committee passes Bill and also recommend that our insurance company fund primary care addict. At least we do not lose more primary care clinics. This is so critical. We're so short of providers.

And thank you for your time this morning.

Thank you. That's everyone indicating they'd be joining us today. Also testimony and support from seven organizations and eight individuals. Anybody else in the room wishing to testify?

Chair.

Anybody on Zoom? Go ahead.

Chair. Good morning. Chair. Vice chair. Committee Members. I'm Kylie Swan. I'm strong supporters built because health care provider is most important in the community setting and I have a Medicaid provider So I go doctor every day. I Dr. Kapilani Medical center for Women Children to check on my eyes.

I go to the dentist, check on my teeth and go to my primary doctors at the Queen's urgent Care. They called it Empower Health. It's about like 10 minute walk from my house to the to the facility.

So I'm very proud to support this Bill and please pass this Bill in the future so that we can get this show going and they cannot testify. They. Please send me question. Sorry for being late.

Thank you. Anybody else on Zoom?

All right, thank you. Members, any questions on this measure? Thank you. Rep Kusch.

Chair HMSA, thanks for coming out. You know that Dr. Grosskreutz pointed out some figures in Dr. Lewin, what do you, what do you think? Because it seems externally that it would be in both the insurers and the industries best interest to support primary care providers. And you know, I can viscerally see their decreasing numbers.

Is it not an HMSA as the largest insurer's best interest to kind of see the longevity in the industry or do you. I mean, I'd just like to hear your perspective on that.

Oh no, we absolutely agree. Primary care is a critical and foundational component of our healthcare system. We believe definitely in investing in our primary care network and all of our providers. I think, you know, as Dr. Lewin also pointed out previously, it's just very complex. As we look at how do you define primary care?

There was a lot of complexities I think in the original Bill. We would very much so appreciate the effort of this working Committee to be able to sit together and develop the plan of how do we better invest and really look at the numbers across the board.

Okay, so you think that this bill would help kind of provide a pathway forward to support primary care providers. And you know, obviously I know the intent of the original bill is to give them better reimbursement rates instead of directing some of that money to third party. I don't know, I'm going to use it the wrong word.

I'm sure there's an industry word for people who make decisions about pre authorizations and stuff along that line. Do you think it will lead to a better outcome from our primary care providers?

I think together with the working group, yes, that in the end we will come to a conclusion that is going to be in the best interest of our community as a whole because we're not looking at just reimbursement. We want to ensure that there's quality of care, that there's future investment into our community. Community.

And so again I think the working group is the best approach forward because we are going to have everyone together to understand all sides of the perspective.

Okay, thank you Chair. Thank you. Thank you. Thank you Members. Anything additional? Seeing none. We're going to move on to HB 1966 HD1 relating to the Emergency Medical Services Special Plan.

We have the Department of Health and Support. Thank you Tax foundation of Hawaii with comments on Zoom.

Thank you Chair Vice Chair Members of the Committee Tom Yamachika from Tax Foundation. We think this bill is good.

It aligns the revenue source better with what the special fund is, but we think that concomitantly with that we should get rid of the earmarks on the vehicle reg fee and the tobacco tax because those have no nexus with emergency services in our view. Thank you for allowing me to speak. Happy to answer any questions.

Thank you. We have Laura Mallery-Sayre in support on Zoom.

Good morning to Chairman Todd and Vice Chair Takenouchi Committee Members. My name is Laura Mallery-Sayre. I am the co founder of the Daniel R. Ser Memorial foundation and for the past 28 years I have served as the Executive Director of this nonprofit which provides life saving equipment and training for our Fire Department personnel through default.

I have become a bit of an expert on the difficulties surrounding the acquisition of emergency equipment to meet the needs of our first responders, particularly by the state and the counties due to the lack of funding and the onerous procurement processes that are currently mandated.

I'm speaking to you today to urge you to modernize the Emergency Medical Services Special Fund to allow adequate funding for necessary medical vehicles and training to be made available in immediately by exempting the procurement process for this Department for these needs.

It often takes up to two years or more to simply apply for these needs through the existing procurement process and then you need to add on that to that time frame the backload of vehicles available nationally which can add on to another three or four years.

If we're going to be truly responsive as a state, we need to be able to order needed vehicles immediately to serve our communities. Technology has changed significantly since 1984 when the statutes, rules and regulations governing the Department were last examined. We need to be proactive instead of reactive when there are lives at stake.

This means that our first responders should be provided with the very best equipment and training that is available. I urge you to pass this Bill and to exempt the DOH Emergency Medical Services Department.

With the exception of the existing procurement process, our needs on the Big island are extremely dire and we don't have enough ambulances and when one does break down we can't get another one quickly.

We don't have the support for the personnel to add on new ambulances and it sometimes takes an hour and a half in one direction to get to people who need EMS care and then another hour and a half back when minutes count.

This is critical so I urge you to support the Emergency Medical Advisory Report and To get those procurement processes eliminated for them. We need to get our equipment correct quickly. And I really appreciate the time today. I apologize for being late with my written testimony.

I know those of you are on the Committee for the from the Big Island know exactly what we're talking about. I appreciate it. Thank you for your time.

Thank you. That's everybody who indicated they would be joining us today. Also testimony with comments from the state procurement office. Anybody else in the room wishing to testify?

Good morning Chair to me Member this is Kylie Swan. I'm a big supporters bill because emergency services vehicles is most important. The last testifier was saying because if one vehicle breaks down and it ruins a whole 91 ruined a whole 911 emergency response.

So can you please pass this bill and please and please get this Bill forward and the client testified and please let me have any question.

Anybody else on Zoom?

Members any questions on this measure saying none. We're going to move on to the next item. HB 1969 HD2 relating to colorectal cancer.

Have the Department of Human Services with comments on Zoom.

Aloha Chair, Vice Chair, Members of the Committee I'm Meredith Nichols on behalf of Department of Human Services and will stand on our testimony. Mahalo.

Thank you. We have DCCA Insurance division with comments.

Morning Chair, Vice Chair Members of the Committee I 'm Justin Chu from the Insurance Division stand our written testimony providing comments.

Thank you American Cancer Society Cancer Action Network and support.

Thank you Chair, Vice Chairs and Committee Members Cynthia Allen on behalf of the American Cancer Society Cancer Action Network and we testify in strong support of this measure. Mahalo for considering this bill. Cost remains one of the most significant barriers to preventive cancer screening.

Uninsured adults are far more likely to get diagnosed in late stages when treatment is more complex and expensive and less effective for colorectal cancer.

Late stage diagnosis often cost over $100,000 as Hawaii anticipates the increase in uninsured adults with changes in access to Medicare coverage beginning at the end of this year, this public assistance program becomes even more critical to ensure access to preventive screenings. We respectfully urge the Committee to consider

this as a dedicated funding for early cancer prevention for uninsured adults. And no one in our community should forego life saving access because of costs of concerns or lack of insurance. Thank you. I'm available for questions.

Thank you. That's everyone who indicated they would be joining us. Also comments from the Department of Health and testimony and support from 5 organizations and 13 individuals. zero a chair. Sorry Ky, can you hear that?

We have someone in the Room.

That's me. Chair. This is Kylie Swan. I'm install support of this bill.

Okay. Thank you. Sorry.

I'm strong support. Sorry.

Okay. Thank you.

Good morning. I'm Vice Chair Takenouchi. And I'm Chair Chris Todd. And Members of the Committee. I'm Lola Irvin representing the Department of Health. So the Department of Health offers comments on HB 1969 HD2. We really promote early detection.

And so in order to do that and to help people achieve optimal health and long years of life, I like to say we like to have people start with a twinkle in their eye and end with a twinkle in their eye. Having lived a good long life.

We are putting on a Get Screened Hawaii Colorectal Cancer Screening campaign that will start March 1. So you'll see it Monday, and it'll go through June 30. And it's because our screening standards have changed. So people age 45 should start to get screened for colorectal cancer.

And what we know in the US Is it is the leading cause of death for people under age 50. And so early screening and regular screening is very important to extend those quality years of life. I do have some 2024 data. And so for our age group, 45 to 54 years of age, only 53% reported getting screened.

And for those that are 55 to 64 years old, 76% and 65 to 75 years old, 80%. So it looks like our retirement years are really good for screening. But for those who are working, they need our encouragement. And for those who are uninsured, 29% who are uninsured said they did not meet the screening standards.

So we offer these comments and thank you for hearing HB 1969.

Thank you. Anybody else in the room, which she testified, please come forward. Just state your name and position for the record before you start.

Thank you, Chairman Todd and Vice Chair, Members of the Committee. My name is Linda Asato, and I'm in strong support of this bill. My grandfather died of colorectal cancer, three of my uncles and my auntie. And I'm very aware of the need to have colonoscopies when I have such a strong family history.

And I totally support this bill for those who are underinsured and not insured. Thank you for listening.

Thank you. Anybody else in the room? Anybody else on Zoom?

Chair, Vice Chair, Honorable Members, we didn't support testimony on this because we realized that others in the Department of Health were going to come in with a strong testimony. But we strongly support this bill. Thank you.

Thank you.

Chair. Good morning, Chair. Vice Chair, Community Member. I mean I'm in strong. I mean a. I'm written strong supporters. Bill, thank you for letting me testify.

Thank you.

Members. Anything, any questions? If not, we're going to move on to HB 1973, HD1 relating to health.

First, we have SHPDA in support.

Yes, strong support. Strong. 973 I'm sorry.

Lost in my package here. Okay. Chair, Vice chair. Yes, this is Kupuna Caucus. I, I would appreciate just being able to make comments. The Kupuna Caucus idea, the Kupuna Aloha idea, came out of our Advisory Council on Kupuna at Shipta. The idea is to address that population of Kupuna who do not have home care service access.

And that's frankly the traditional Medicare beneficiaries. If you're eligible for Medicaid, you have access to transportation services, food support, and many other support services, including home health. If you are a Medicare beneficiary in traditional Medicare, you do not have home health services.

This Bill would provide, in a very inexpensive way, for less than $1,000 a beneficiary per year, the ability to have somebody visit the person at home, connect back to the primary care doctor, and monitor the patient's health and wellbeing. Where community health workers are available, we'll be using them. We're not and we have nowhere near enough community health workers to meet this need.

There's probably 25 to 30,000 very frail seniors who need this kind of support and there's no services available. Where those people aren't available, we're going to use volunteers.

We have programs like Project Dana, Hui...and others that already are doing this kind of work with no reimbursement or support whatsoever. So, we're going to expand. We've talked to a number of churches and community associations and clubs who are willing to come up with volunteers for their immediate neighborhood.

So, this real inefficient way, all we need to do is to fund some training and some vetting for the people that come in, a bit of support for them, give them an iPad, and allow them to go out and see their, their beneficiary in their neighborhood and then report back in as to how they're doing.

We know this is going to reduce hospitalizations, Emergency Department visits, state costs because we pay for some of these services in indirect ways and Medicare doesn't cover a lot of these benefits. So, this is an important area to go.

Half of the money for the request for this is coming out of Rural Health Transformation for our neighbor islands. But this request in this Bill allows us to put $2 million toward providing 500 to 1,000 beneficiaries in urban Honolulu where most of the people are actually going to be. So, this is a—so, we're dual funding it. Roja for the neighbor islands and this program for Oahu. Please support this Bill. Thank you very much.

Thank you. Executive Office on Aging, with comments.

Executive Office on Aging will stand on our comments. Thank you.

Thank you. That's everybody who indicated they'd be joining us. Also, testimony in support from the Disability and Communication Access Board. One second, Kaili, where I'm finishing up the written testimony.

Testimony in support from the Disability and Communication Access Board, two organizations and four individuals. Anybody else wishing to testify? Okay, go ahead. State your name and position and go ahead.

Good morning, Chair, Vice Chair, Committee Members. My name is Kaili Swan. I'm in the written—strongly written testimony support. Thank you for allowing me to testify, Chair.

Anybody else wishing to testify?

All right, thank you. Members, any questions?

Chair, for Shipta. Dr. Lewin, the Bill proposes the pilot program to cease to exist on June 30th, 2027. So, my question is, is that sufficient time to determine whether or not this pilot project is effective and needed or should the length of the pilot project be extended?

Thank you for that question, Representative Hartsfield. It really isn't long enough. We will have to come back and show that it's working. It's going to take six months or so to just get started with the program.

There's going to be, there is, there is a home health agency that's willing to right now start the program by doing a complete assessment on anyone that's referred. The primary care doctor or clinic can refer people in. It'll take a while to set it up.

This was, this was one of the measures the Kupuna Caucus, your own Kupuna Caucus, has strongly recommended. But we would have liked it to be at least a minimum of a two-year pilot project, and we certainly would still approve that. I'd be happy to, to implement it if you could do that. Thank you.

Anything additional? Yeah. Go ahead.

Dr. Nguyen. Sorry. Thanks.

Actually, it's good to get up and down.

In your testimony, you mentioned the rural transformation healthcare prep.

Yeah.

And just real quick, what is the timeline on the deployment of those dollars? I know we secured that at the tail end of last year and there's—we're discovering the guardrails, I think, as we speak.

But I'm just trying to figure out how quickly we can fund and then to your point, you know, provide the right timeline to develop the measurements.

Thank you for that question, Representative Keohokapu-Lee Loy. Actually, I think the—we're still in negotiations with CMS on this. We have to encumber all the money for this year before September 30th. We believe we'll be getting some procurements out way before that, but we're still kind of going through negotiations back and forth.

So, this program, if it was funded by and it will be, it's approved by, at least in principle, by CMS. It might not really get launched until mid-summer or late summer. So, it's going to be—this one could start a little sooner if it was funded by the Legislature.

But the other program can be funded year after year and be expanded in future years. So, actually, we should be able to be more services to neighbor islands because we have more funding available.

Okay and then real quick, what is the timeline and the spend down for the Rural Transformative Health Care Grant and the first tranche of...?

It must be spent by the end of the next fiscal year. So, that would be September 30th of 2027.

Thank you, thank you,

Thank you. Anything additional? If not, we're going to move on to the next item, HB 1974 HD 1, relating to health.

First we have SHPDA, in support.

Hi. I'm Jack Lewin. I'm sorry that I have so-- we have so many bills here, but there's a lot of important issues. I just wanted to speak about the comments. We're in support. There have been previous bills in previous years to try to address hearing loss in the state which haven't prevailed.

It's kind of a forgotten issue for a lot of folks in healthcare, but it's important. We screen a lot of our kids, but we don't even screen all of our keiki in school, and hearing loss for kids in school that isn't detected really affects their learning ability, obviously.

And for adults, by the time people are 80, the majority have hearing loss, and many don't get care or therapeutic help in that area, but we also have a whole host of adults who have sudden hearing loss after viral infections and other-- sometimes undetected, and this is devastating. They can't work.

They can't deal with their activities of daily living in a normal way. So what we'd like to do with this money is really just assess the issue, determine what we should be thinking about in terms of a plan in the future to address hearing loss. It's an important issue and it's forgotten one. We would hope you will support this very modest funding request.

Thank you. Executive Office on Aging, with comments.

We support the-- we stand on our testimony, offering comments. We support this. Thank you.

Thank you. Alzheimer's Association Hawaii, in support.

Aloha, Chair, Vice Chair. Coby Chock with the Alzheimer's Association. We're in support and we'll stand on our written testimony. Thank you.

Thank you. Here for Hope, in support on Zoom. In person.

Aloha. My name is Tori Carapelho, and I'm the founder of Here for Hope. I come before you both as a community advocate and as someone who has lived experience. In 2021, I experienced sudden hearing loss.

I remember being told that there was nothing more they could do, that this was something that I just had to learn to live with. In that moment, I wasn't just losing my hearing. I was losing my confidence, my independence, and my ability to communicate. What made it even harder was realizing that there was no clear path forward.

A diagnosis was addressed, but there was no road map, no coordination, no guidance, and no clear place for me to turn to for support. I also learned that hearing devices alone just don't do enough. You know, it's education, assistive tools, and ongoing support. Those are all the things that make the difference between isolation and participation.

And too many people, they just don't have the access to it. I was fortunate, but many are not. That experience led me to start Here for Hope because no one should have to navigate hearing loss in such a fragmented system. Through our work, we hear the same stories again and again.

You know, people don't know where to go, care paths are confusing, providers are stretched thin, and services are disconnected. Hearing loss affects far more than just hearing; it impacts communication, employment, independence, and the quality of life, and as Hawaii's population continues to age, these challenges will only grow.

House Bill 1974 is an important opportunity for us to take a proactive, coordinated approach. A statewide plan would help us to identify gaps, strengthen early detection, support workforce development, and ensure community voices are part of that solution.

Both through my lived experience and my work within the community, I can clearly say that the need is real, the gaps are significant, and the cost of inaction is high. Mahalo for this opportunity to testify. Respectfully ask for your support. Thank you.

Several indicated they would be joining us. Please note additional support from four organizations and 40 individuals, as well as two individuals providing comments. Is there anybody else wishing to testify? Yes.

Hello, Chair and Vice Chair and committee members. My name is Bryan Mick. I'm here on behalf of Acting Executive Director Kristine Pagano and the Disability and Communication Access Board. We are in support of this bill.

Tens of thousands of Hawaii residents experience loss of their hearing, and our aging demographic is only going to accelerate this trend. If left untreated or unmitigated, there are associated risks with this, such as cognitive decline and dementia, and as you've heard, those are very expensive to treat, so if we can avoid those, that is to be done.

The comprehensive plan will allow for limited resources to be optimally deployed when providing program services, auxiliary aids, and treatments as appropriate, and I'm sure DCAB is looking forward to, hopefully, participating in the development of this plan. Thank you.

Apologies. I don't have you on the list, but if you have the written testimony, give it to the staff. We can double-check, make sure it gets online.

We didn't get it in time, Vice Chair. Thank you.

Thanks. Anybody else wishing to testify?

Thank you, members. Any questions?

Can I have Dr. Lewin come up? It should be easy question to answer. So I do represent Waipahu, but there are times it feels like I'm on the neighbor island, so I have to ask about this rural healthcare grant. Would it be applicable to something like this? Could that be another source of revenue to fund this project?

It wasn't in our original-- we had to put our proposal together in less than a month as a state, and the governor led the process and he did an amazing job with it of just forcing out something that got-- not only the minimum we would get would be 100 million a year, but we got 189 million a year. So we got actually more money per capita than any other state in this rural health transformation piece. It's kind of a-- you know, Wahiawa and Mililani are kind of in a quasi-zone and can we say that they're rural?

We think we can. We think we can provide resources there. For this particular program, it wasn't in our proposal, so it would have to wait until year two if we were able to try to insert it in. I'm sure there will be many changes in what we propose the first year when we get around to seeing what we want to put in the second year and the subsequent years.

Thank you. And just for future reference, for our rural community representatives, that's probably something we're interested in, so you can just tell us right off the bat and then we won't ask.

Well, you know, I think it's questionable. You know, I mean, Kailua and Kaneohe weren't considered rural, but obviously Waimanalo is right there next door and that's rural. So we can reach in from urban-- I mean, we could place resources in areas that aren't rural if we sort of can qualify that the residents really need the service, just like people on the neighbor islands.

Okay, thank you. Thank you, Chair.

Thank you. Anything else? If not, we're going to move on to HB 2315 HD 1, relating to state employee benefits.

Department of Health, in support.

Good morning. Good morning, Chair, Vice Chair, and members. My name is Bobby Robinson. I'm the Departmental Human Resources Officer at the Department of Health. We stand on our testimony, and I would just like to highlight that this is a budget-neutral request. And we're here for any questions.

Thank you. We have HGA, in support.

HGA will stand in support. Thank you.

Thank you. Also, written testimony from one other organization in support, members. That's everything we've received. Anybody else in the room wishing to testify? Anybody on Zoom? Yeah, go ahead.

I'm in strong-- in support.

Thank you.

Okay. Members, any questions on this measure? If not, moving on to HB 2343, relating to veterans.

We have the State of Hawaii Department of Defense, in support.

Good morning, Chair, Vice Chair, members of the committee. The department stands on its testimony in support and available for any questions.

Thank you. HHSC Oahu Region, with comments on Zoom.

Good morning, Chair, Vice Chair, committee members. The Oahu Region will stand on our written comments. Available for any questions.

Thank you. Hawaii Office of Veteran Services, in support. Oh, they did not-- be here. Thomas Driskill, in support.

Mr. Chair, Vice Chair, Honorable members, Thomas Driskill for U.S. Army Medical Service Corps. As an individual testimony, I stand in strong support of this bill, and I'm here for questions, should you have any. Thank you.

Thank you. That's everyone who indicated they'd be joining us. Additionally-- yes, Hawaii Office of Veterans' Services, one other organization, and four individuals, all in support. Is there anybody else in the room wishing to testify? Anybody on Zoom? Kaili? Hi.

I'm in strong support.

Thank you. Anybody else on Zoom?

Any questions, members? If not, SB-- oh, sorry. Getting ahead of myself. HB 2501 HD 1, relating to healthcare.

We have SHPDA, in support.

Good morning, Chair, Vice Chair, and members. I'd like to add a few comments to this bill. I don't know who proposed it actually, but it's a very powerful measure for us at SHPDA. I'd just like to just use one minute to provide a little bit of education to folks.

You know, we have this massive partnership that's being proposed with our biggest insurer and a large hospital system, we have lots of chaos in our system, and the real reason for this that we don't seem to kind of all understand together is that we are so underfunded by the federal government in both Medicare and Medicaid on a per capita basis. Our Medicare beneficiaries here get about $9,000 per beneficiary. The national average is approaching $13,000. That's a 40% difference in reimbursement.

And the problem is, we're similar to Wyoming, and North and South Dakota, and Montana, and some other states that have about a little bit higher, but about where our reimbursement per capita is, but they have very low cost of living, and this Medicare under-reimbursement is really putting stress on everybody.

It's the primary care stress to some extent, but it's the hospital stress. Every hospital's losing money on Medicare, and then the Big-Not-So-Beautiful Bill just added a requirement that means that Medicare reimbursement has to go back to 100% of Medicare.

Our Med-QUEST agency was taking us up to 150% of Medicare to keep the hospitals afloat, okay, and to keep others afloat in the practice. This bill will help us quantify where we have these super high Medicare costs that we can help justify getting our rate up. We're going to need to do an addendum to a bill.

Thank you last year for giving SHPDA the $250,000 to get a study done, which we're finally getting through the procurement process to get moving. So I appreciate that. The second thing is, it also wants to know-- wants to monitor who's uninsured. We also need this data, particularly given the HR 1 impacts on the rising numbers of uninsured.

So thank you for approving this because we think it could help us monitor where we are and help us justify to the feds the increases we need in the Medicare and Medicaid per capita reimbursement. Thank you.

Thank you. That's everyone indicating they'd be joining us. Also, testimony with comments from the Office of the Auditor, the Hawaii Health Systems Corporation, and two organizations. Is there anybody else in the room wishing to testify? Anybody on Zoom? Yes, just go ahead. Just state your name for the record and proceed.

This is Kaili Swan, Chair. I'm in very strong support because people with disabilities is most important to help and they cannot testify. Support.

Thank you. Anybody else on Zoom?

Members, any questions? If not, HB 2505 HD 1, relating to assisted community treatment.

We have the Department of Health, in support.

Good morning, Chair, Vice Chair, members of the committee. My name is Courtenay Matsu from Department of Health. I wanted to clarify some of the comments that we had provided. This bill, we do support, for assisted community treatment.

The amendment that we have requested is to really address the time that it takes from the filing of a petition for assisted community treatment to a decision. So assisted community treatment is a mechanism for us to really try to maintain folks out in the community who have severe mental illness but may be non-adherent to their treatment plans.

So this is a mechanism for us to get a court order to ensure that they continue the medications and continue going to service-- get case management services, get their other types of treatment that they might need. Right now, it can take up to maybe three months for us to file the petition and then get a decision, and during that time period, if the person is in the hospital and they're ready for a discharge, we have to discharge them, and then it might be difficult to then find the person once they're discharged to serve the orders.

This would also help community hospitals, too, who also can file these petitions, and under the other-- similar to HSH, when somebody is ready to be discharged, have to be discharged. So I understand on Judiciary side the difficulties, perhaps logistically, and in times where there might be a need for guardian items to find them and get that in place, but I do hope that people will consider the amendment that we had provided. Thank you.

Thank you. That's everybody who indicated they'd be joining us. Also, comments from the Judiciary and support from one organization and one individual. Is there anybody else in the room wishing to testify? Anybody on Zoom?

Members, any questions? If not, we're going to move on to HB 1577, HD 1, relating to 9-1-1 services.

Department of Health in support.

We stand on our written testimony.

Thank you. Hawaii State Council on Developmental Disabilities in support.

Aloha, Chairs, Committee Members. My name is Chase Silvert with Hawaii State Council on Developmental Disability. We'll stand our written testimony in support. We really just want to emphasize that the point of this is to make it statewide. We already have it on Oahu. We've been using it a lot. It's also on Maui.

So, we just wanted to emphasize it statewide is the point of the pilot project. Thank you so much.

Thank you. That's everyone who indicated they would be joining us. Also testimony with comments from—ne second, going over the written testimony. Comments from the State of Hawaii 911 Board, the County of Kauai Police Department, three organ—sorry, both those organizations with both those agencies with comments. Testimony in support from three additional organizations and five individuals.

Is there anybody else wishing to testify? Sorry, we're going to do the room first.

Aloha, Chair, Vice Chair, Brian Mick with the Disability and Communication Access Board. We are in support of this Bill. Prior to the development of Text 911 going live in October of 2016, BCAP coordinated with the Honolulu Police Department and Emergency Management Services to educate the disability community about this option.

Establishing a working group for a statewide emergency safety profile system pilot program would ensure that people with disabilities can voluntarily participate in the system by sharing their personal relevant information to the emergency responders for their immediate use when they're responding by police, fire, and ambulatory services.

DCAB recognizes the value of and privacy of sensitive information, especially when someone's disclosing a disability, medical, or health condition. So, the hope is that the working group can review and address cybersecurity, data retention, and deletion of profiles. Thank you for the opportunity to testify.

Thank you. Anybody else in the room?

Thank you. Carolyn Cartirao with the Executive Office on Aging. I don't know how this one slipped by me, but the Executive Office on Aging stands in strong support of this measure. Thank you.

Thank you. Anybody else in the room? Anybody on zoom?

Chair.

Yes. Please state your name and proceed.

...Committee Members, my name is Kaili Swan. I'm in very strong support of this Bill because I use Smart 911. It is very simple and DD Council and staff helped me how to set it up and it's and I and it's pretty good because some people with disability doesn't know how to speak to 911 operator. So, this tool is very helpful.

It helps very lot and is very useful. And please...and thank you for letting me testify.

Thank you. Anybody else on zoom?

Thank you. Members, any questions on this measure? If not, moving on to HB 2443, HD 1 relating to disaster services.

We have the Department of the Attorney General with comments.

Good morning, Chair Todd, Members of the Committee. Deputy Attorney General Ryan Endo on behalf of the Department of the Attorney General. Our comments are provided in our written testimony. I'll be available for any questions.

Thank you. We have the Hawaii State Council on Developmental Disabilities in support.

Hello, Chair, Vice Chair, Committee Members. My name is Savannah Peskin. I am the Maui Program Specialist with the Hawaii State Council on Developmental Disabilities, here on behalf of our Executive Administrator, Danger Bartoldis. We will stand in our written testimony in strong support of HB 2443.

We just wanted to emphasize that the bill's purpose is that many people do not identify as having a disability. However, they still might have an access and functional need that can be defined as any need that you have to access the community like refrigerated medication, a mobility issue, anything like that.

So, it's a lot broader of a scope than just disability. And we wanted to also say that we are in support of the previous committee's amendments, and we are also in support of the recommendation of the $200,000 which establishes the position of $100,000 and then $100,000 for programming. We will be available for any questions.

Thank you guys so much.

Members, that's everyone who indicated they'd be joining us. Please also note testimony in support from the Hawaii Civil Rights Commission, HYEMA, and the Office of Wellness and Resilience, as well as four organizations and four individuals. Is there anybody else in the room wishing to testify? Please.

Once again, hi Chair, Vice Chair, and Committee Members. Brian Mick here for Executive Director Christine Pagano and the Disability and Communication Access Board.

We are in strong support of this Bill and integration specialists would ensure that the needs of individuals with disabilities and others with access to functional needs are included in all phases of emergency management, including planning, response, recovery, and mitigation. In addition, they could be deployed to disaster sites to provide technical assistance.

We note that one in five residents have a disability and may require additional support before, during, and after disasters.

People with disabilities encounter disproportionately risks including difficulty evacuating without proper support, lack of accessible transportation, barriers to receiving emergency alerts and evacuation orders in accessible formats, obstacles in accessing shelters and barriers in receiving appropriate emergency medical care and in accessing post disaster relief programs such as housing, food, and financial assistance.

We've seen examples of all of this in the past couple of years between Covid, the Lahaina fires, and the tsunami evacuation last year. We do support, as suggested in the last Committee report, that the 200,000 be reinserted into the bill with 100,000 for the position of 100,000 programming costs.

Thank you. Anybody else in the room? Anybody on Zoom?

Chair?

Yes, go ahead.

Good morning, Chair, Vice Chair, Committee Members. My name is Kaili Swan. I'm in very strong support of this bill because emergency preparedness is most important.

Anyone but including...and we have a program called Feeling Safe, Being Safe Program for people with disability, how to train, how to put—how to prepare in case of emergency and this program is based out of California so it's from...

So, can you please let me know—please pass this Bill and take my testify please...any question you have? Now you have the floor chair.

Thank you. Anybody else on zoom?

Members, any questions on this measure? If not we're going to move on to HB 2498 HD2 relating to care homes.

We have the Department of Health in support.

Good morning Chair, Vice chair, Members of the Committee. My name is Paula Cerio. I'm the chief for the Office of Healthcare Assurance Department of Health. We stand on our testimony in support of this measure. Thank you.

Thank you. Executive Office on Aging with comments.

Executive Office on Aging offering comments. I'm available for any questions. Thank you.

Thank you. Navian Hawaii in support, not present. That's everyone who identified themselves as joining us Also testimony and support from HEMA three organizations and two individuals. Is there anybody else in the room wishing to testify? Anybody on Zoom Members?

Any questions on this measure? If not, we're moving to the second to last item, HB2581HD2 relating to emergency management.

We have ACLU of Hawaii in support on Zoom.

Morning Chair, Vice chair, Committee Members. My name is Wookie Kim. I'm the legal Director of the ACLU of Hawaii. I'll get right to the point. This Bill is absolutely necessary. Emergency powers are supposed to be rare and that's because when they're invoked, we give the Executive extraordinary authority, including the power to suspend democratically enacted laws.

Back in 2014, when this Legislature modernized our emergency management law, the focus was clearly on things like hurricanes, wildfires, floods, disease outbreaks, not long standing public policy challenge. But the Hawaii Supreme Court recently said an emergency can include long standing problems that reach crisis levels.

That's a major shift and it's also a dangerous shift because once a decades old policy issue can be labeled an emergency, emergency power stop being exceptional. They start to look like another way to make policy unilaterally and outside of the legislative process.

We're not minimizing the seriousness of the housing crisis because it's real, but so are many other serious challenges we face. And if every crisis can be declared an emergency, then emergency authority becomes the norm, not the exception. This Bill draws a clear line which is that if there's a sudden catastrophe, emergency powers are okay.

But for long standing policy, that belongs here before this body in this Legislature, we ask that this Committee advance HB2581HD2. Thank you.

Thank you Sierra Club of Hawaii in support on Zoom. Not present Earth justice in support.

Aloha Chair, Vice Chair, Committee Members. My name is Dru Hara. I'm at Earth Justice. So we submitted written testimony in support emphasizing that the need for this Bill to restore the proper constitutional balance of power between the Legislature and the Executive branch. We'll, we'll stand on that.

I wanted to add some comments today to hopefully clarify what this Bill does and does not do and and address some of the concerns raised in opposition by the emergency management agencies. So under Chapter 127a, HEMA and the county emergency management authority already have a menu of existing powers that operate in any time.

We don't need an emergency proclamation and those powers are under 127A12. Those allow for things like procurement, planning, training, preparedness, making response plans, emergency planning. So these are all things that will be totally unaffected by this Bill. Right. So when we're looking forward, how do we best prepare, anticipate emergencies that might be coming down the road?

This will not happen HEMA or our county agencies in any way. What this Bill does affect are the additional powers under 127A13, which are the governors and the mayors in the county case, extraordinary powers, including the power to suspend any law. Those, those provisions are triggered under 127A14, declaration of an emergency.

And so the definitions and the amended definitions in this Bill are just looking to narrow the definitions of emergency in response to the Supreme Court's Nicola decision to bring the terms emergency and disaster back in line with the original intent of the Legislature.

So in the county, Honolulu County, excuse me, Dem's testimony, they raised some concerns about language in the preamble of this Bill about unprecedented size and destructiveness. Just want to point out one, that language is in the preamble. It's not anywhere in the amended definition. So that's not raising a new legal standard.

And I think more importantly, that language is actually taken directly from 127A1, which is existing language within the statute that defines the purpose and the policy of the Emergency Management Act. So to the extent that anyone is bristling at that, it's. It's only in the preamble. If that needs to be taken out, I think that's. That's fine.

The other thing I wanted to address is really quickly, and I'll stay on for questions after, is this idea that narrowing the scope could lead to litigation in the times of emergency. Under 127A-27, there is a very comprehensive procedure outlined for how citizens can challenge an emergency proclamation.

It is an expedited process that allows temporary restraining order or preliminary injunction and a ruling within a matter of days outside of sort of the normal litigation track where, you know, there might be concerns that litigation can go on for months or years at a time.

Just as an example, this, this is something that has played out before in the context of Governor Ige's emergency proclamation relating to Mauna Kea. During the TMT protests, there was a citizen who challenged that the 127-A27 provision. Within a matter of days, a panel of three Circuit Court judges was assembled.

They were able to come out with an initial preliminary injunction specific to that one citizen that would allow him his constitutional, traditionary and customary practices and access rights. But that left the emergency order in place broadly so that we could still continue to protect public public safety.

So I think some of the concerns raised by the emergency management agencies are a little bit overblown and represent kind of a misunderstanding of what this Bill is actually doing. So we stand in strong support. And again I'm here for any questions, if you have any. Thank you.

Thank you. Chrysler's Institute of Hawaii in support, not present. That's everyone who indicated they would be joining us Members. Also testimony in opposition from HEMA, as well as the City and County, Honolulu Department of Emergency Management, testimony in support from three additional organizations and 18 individuals. Is there anybody else in the room wishing to testify? Anybody on Zoom?

Members, any questions on this measure?

No. All right, we're going to move on to the last item on our agenda. HB 2622 HD1 relating to language access US SHPDA in support.

We stand on our written testimony in strong support. Thank you.

Thank you. Roots Reborn Maui in support on Zoom. Hawaii Coalition for Immigrant Rights in support.

Todd and Vice Chair Takenouchi, Members of the Committee, Hawaii Coalition for Immigrant Rights. We represent about 30 immigrant serving organizations across the and we've been working very actively.

About two sessions ago, we were able to work with HEMA to get a full time language access coordinator within within HEMA and that was a direct result of advocacy from organizations that we worked with in lahaina for whom 30% of the survivors of the Maui wildfire were limited English proficient and foreign born.

And so this is a part of our process in moving forward and making sure that we have both blue sky and gray sky materials ready for for the various disaster scenarios that we're preparing for.

For example, if we were to have like a tidal wave that hit Haula, we would need to make sure that we rolled out Tongan language resources immediately. Not then, you know, find and film materials at Tongan once it's already happened.

But so this funding goes towards making sure that we have those ready to go for the disaster scenarios that we think are likely.

Thank you. We have Christine Andrews in support on zoom.

Thank you for the opportunity to testify. Yeah, my name is Christine Andrews. I'm an attorney based in Maui and I do want to reiterate what Liza said about the need to be properly responsive to our non English speaking community.

So in Lahaina before the fires, about 1/3 of our residents were foreign born and also about 36% age 5 or older spoke a language other than English at home. We have again large Members of the COPA community, a lot of Tongans and Philippine Members of our community who are at risk during the Lahaina wildfires.

And we feel it imperative that Hawaii Emergency Management Agency be responsible to the needs of our non English speaking community in times of disaster. Thank you so much for the time.

Thank you. Circling back one more time to Roots Reborn Maui on zoom.

Okay.

Okay. Anybody else in the room? Oh, that's all the written testimony we've received. Also testimony in support from HEMA, the Hawaii civil rights commission, three other organizations and 14 individuals, as well as one individual providing comments. Is there anybody else in the room wishing to. No. Smile, please.

Just state your name and position for the record and proceed.

So, hi, Chair Todd, Vice Chair and Members of the Committee. My name is Ana Flores. I am a fellow at the Legal Clinic. So. So I'm testifying on behalf of our board President, Amy Agbayani. And we stand in strong support of bill HB 2622.

Many of the workers at TLC and of course the people that we serve are immigrants, ourselves included. We draw from our experience as immigrants and from our work with those communities we've been helping serving communities, communities in Maui and the ones affected at the Lahaina fires and going back to the COVID 19 pandemic.

So government, private companies and nonprofit organizations need qualified personnel to provide language access, especially in times of emergency. The recent weather emergency announcements just days ago should have been available in multiple languages to ensure safety with the system from government agencies. And strengthening language access capacity within HEMA is therefore critical to provide an effective emergency response statewide.

Thank you so much for the opportunity to give these comments.

Thank you. And we do have your written testimony. Anybody else in the room? Anybody on Zoom?

Members, any questions on this measure? If not, we're going to recess briefly prior to decision making. Recess.

Aloha. We are reconvening the House Committee on Finance for the purpose of decision making on our 10am Friday, February 27th agenda, again here in room 308. First on our list is HB 816 HD1 relating to emergency response. The Chair's recommendation is to move this forward as is. Are there any questions or comments? Seeing none. Vice Chair.

[Roll Call]

Thank you. Next, we have HB 1535 HD 1, relating to automated external defibrillators. The chair's recommendation is to move this forward, amended as an HD 2, including some necessary technical and clarifying amendments and ensuring that all dates in the bill are defective. Are there any questions on this measure? Seeing none.

On HB 1535 HD 1, recommendation's to pass with amendments, noting the excused absence of Representative Lee, who will be noted as excused for the remainder of this agenda unless otherwise noted, and the presence of all other members. Are there any reservations? Any no votes? Recommendation's adopted.

Thank you. Next, we have HB 1537 HD 1, relating to mental health. Chair's recommendation is to move this forward as is, but I'd like some language in the committee report noting the testimony and potential expansion from the LGBTQ Plus Commission. Any questions or comments? Seeing none. Vice Chair.

HB 1537 HD 1: recommendation is to pass unamended. Any reservations? Any no votes?

Reservations.

Reservations for Rep. Alcos. Any other reservations?

Chair.

And Rep. Gedeon. Anybody else? Any no votes? Recommendation's adopted.

Thank you. HB 1541 HD 2, relating to the Department of Health. The recommendation from the chair is to move this forward as is. Any questions or comments? Rep. Perruso.

I'll be voting with reservations just because it provides for exemptions from civil service.

I understand. And it's something, I think, down the road we'll have to weigh out, kind of like where it's necessary, where it's maybe a little bit of overreach. We'll figure that out over time.

Thank you, Chair.

Thank you.

Okay. HB 1541 HD 2: recommendation's to pass unamended, noting reservations for Representative Perruso. Any other reservations?

Reservations.

Rep. Alcos, reservations.

Same.

Rep. Gideon, reservations. Any no votes? Recommendation's adopted.

On HB 1562 HD 1, relating to youth mental health, similar recommendation to two bills ago. The recommendation is to move forward as is, but note the testimony from the LGBTQ Plus Commission. It's something a future committee can look at in the committee report. But recommendation as is. Any questions or comments? Seeing none.

HB 1562 HD 1: recommendation's to pass unamended. Any reservations? Any no votes? Recommendation's adopted.

Moving on to HB 1574 HD 1. We actually have a few substantive amendments on this measure, so the recommendation will be to move this forward as an HD 2. This is relating to the Healthcare Education Loan Repayment Program. So I'll read this out so we don't mess this up. Okay.

We'd like to clarify the statutory basis of the Healthcare Education Loan Repayment Program by addressing the absence of an explicit program establishment and statute and resolving potential ambiguity regarding whether existing statutory references refer to the same program. Conforming amendments will also be considered-- or will be considered to ensure consistency in program naming and statutory reference.

So largely just cleanup and technical things on that end. We'd also like to clarify that the applicability of the new service requirements-- we'd like to clarify that by expressly specifying that the minimum service obligations apply only to healthcare professionals who receive a new loan repayment program award on or after July 1st, 2027 so that this does not have retroactive impact on the current participants. So again, another kind of technical cleanup clarification.

And lastly, correct any technical drafting issues, including review of the effective date provision to ensure consistency with legislative intent and standard drafting practices. So all three are clarifying but technical in nature to ensure that we don't mess this up. Any questions? Comments? Seeing none. Vice Chair.

HB 1574 HD 1: recommendation's to pass with amendments. Any reservations? Any no votes? Recommendation's adopted.

Thank you. Next, we have HB 1591 HD 1, relating to healthcare. The chair's recommendation is to move this forward as is. Any questions or comments? Seeing none.

HB 1591 HD 1: recommendation's to pass unamended. Any reservations?

Any no votes? Recommendation's adopted.

HB 1853 HD 1, relating to dementia. The chair's recommendation is to move this forward as is. Are there any questions? Concerns? Seeing none.

HB 1853 HD 1: recommendation's to pass unamended. Any reservations? Any no votes? Recommendation's adopted.

Next, we have HB 1854 HD 1, relating to community behavioral health clinics. The chair's recommendation will be to move this forward as is. Any questions? Comments? No? Go ahead.

HB 1854 HD 1: recommendation's to pass unamended. Any reservations? Any no votes?

Recommendation's adopted.

For HB 1871 HD 1, relating to health, recommendation is to move this forward as is. Any questions? Nope?

HB 1871 HD 1: recommendation's to pass unamended. Any reservations? Any no votes?

Any no votes? Recommendation's adopted.

HB 1965 HD 1, relating to primary care. Same recommendation to move this forward as is. Any questions or comments? Seeing none.

HB 1965 HD 1: recommendation's to pass unamended. Any reservations? Any no votes?

Any no votes? Recommendation's adopted.

For HB 1966 HD 1, relating to the Emergency Medical Services Special Fund, the recommendation is to move this forward as is. Any questions? Comments? No.

HB 1966 HD 1: recommendation's to pass unamended. Any reservations? Any no votes?

Recommendation's adopted.

HB 1969 HD 2, relating to colorectal cancer. The recommendation is to move this forward as is. Any questions or comments? Seeing none.

HB 1969 HD 2: recommendation's to pass unamended. Any reservations? Any no votes?

Recommendation's adopted.

HB 1973 HD 1, relating to health. Same recommendation to move this forward as is. Any questions? Comments?

Comments.

Rep. Hartsfield.

Comments, Chair. Just, I would ask the committee notes to reflect that the end date of the pilot project, if they could consider 06/30/28. Thank you.

We can do that. We'll drop some language in the committee report. I think on a lot of these things, there's some things we could probably clean up a little bit, but in the interest of not having a complete meltdown of all of our drafting agencies, some of these things we'll be sending forward with a little bit of work ahead of them, and this falls into that category.

Thank you.

But we'll note that in the committee report. So the pilot date sunset, yeah.

Yes. Thank you.

Okay. Any other questions? Comments? Okay, seeing none. Vice Chair.

HB 1973 HD 1: recommendation's to pass unamended. Any reservations? Any no votes? Recommendation's adopted.

Thank you.

On HB 1974 HD1 relating to health. The recommendation is to move this forward as is. Any questions or comments? Seeing none.