House Standing Committee on Consumer Protection & Commerce

Good afternoon, everyone. We are convening the Committee on Consumer Protection and Commerce. It is Tuesday, March 32026. 2:00pm in Conference Room 320.

Thank you. Okay, just a reminder that we ask that in the interest of time, testimony is kept to two minutes. I have a little timer and when it goes off, I will politely ask you to wrap up your remarks. First on the agenda is HB2323HD1 relating to workers compensation law.

Repeals the requirement that healthcare providers forms be filed with the DLIR in triplicate and clarifies the way a physician transmits. Clarifies the way a physician transmits a treatment plan to an employer. First up is Department of Labor and Industrial Relations in opposition.

We're in strong support of. Good afternoon. Chair Matayoshi, Madam Vice Chair Grandinetti. Jade Butay, Director of the Department Labor Industrial Relations. We stand on our testimony in strong support of this governance package and measure to modernize the Disability Compensation Division's statutory framework. But respectfully request restoration of the Bill as originally introduced. Thank you for the opportunity.

Thank you. Sorry about that. In support. Department of Human Resource Development in support.

We'll stand on our written testimony.

Thank you, Ian. Hawaii Medical association in support. Anyone else in person or on Zoom who'd like to testify on HB20? Seeing none. Members, any questions?

Jade, I know you said you're in strong support and your testimony indicates strong support too. I think someone in your office might have clicked the opposition box, but are you opposed to the Bill as currently written and you're in support of the original language of the Bill?

Yeah, because I think it's under HD1. It removes key components, kind of fragment some of the statutory updates and weakening the continuity and the clarity of the Bill. So that's why we want to go back to the original version. Thank you.

Any other questions? Seeing none. Moving on to HB2324HD1. This Bill repeals the requirement that the DLNR regulate hoisting machines and certify their operators and the Hoisting Machine Operators Advisory Board, including its rules requiring a separate state crane operator certificate. Okay. Department of Labor and Industrial Relations in support.

Aloha Chair, Vice Chair and Members of the Committee, Jade Butay for DLNR. We stand on our testimony in strong support. And thank you for hearing this Administration Bill. Overall, this Bill reduces duplication, improves administrative efficiency, and ensures thorough and timely investigation of retaliate retaliation complaints. Thank you for the opportunity.

Thank you. Anyone else in person or on Zoom would like to testify on this measure? Seeing none, Members, any questions? Rep Iwamoto.

So this would forego somebody getting certified to be a hoist operator. Right. It would basically dismantle the, the body that does the current certification.

And so that if somebody, if this is my understanding of this, so somebody from the continent who's already licensed somewhere else can that their license or certification can be used here, is that correct?

That's correct. Because there's already, you know, operators already have the OSHA-compliant certification. And then this one was just another, another, you know, separate state certificate. So it just adds more paperwork, fees, and delays without really improving, you know, so it's just a duplication.

So what I mean. But with the impact though before would people be flown in then to operate these machines instead of using local or is that, will that not change because there's so many people locally who have the certification and licensure.

We asked our administrator

Chair, Vice Chair, Members of the Committee, Roy Taliai Haas Administrator the union is in support of this move. They have a number of qualified crane operators that adhere to the OSHA standards. So this is with their blessing. Okay, great, thanks.

We've had many productive meetings with them. zero great. Thank you. Thank you. That was very helpful.

There's any other questions? Seeing none. Moving on to HB15 09HD1. This Bill reveals repeals the authorization of a physician to transmit a treatment plan by mail or fax and the requirement that the physician submit it to an address or fax number provided by the employer. Requires the employer to file a response within seven days of receipt.

Imposes a monetary penalty if an employer does not file a response within the seven-day period and clarifies that a treatment plan is deemed accepted if an employer fails to file certain documents within the seven day period. First up is DLIR in support.

Thank you Chair. Madam Vice Chair and Committee Members Jade Butay for DLIR. We stand on our testimony in support. Thank you.

Thank you. Department of Human Resources Development offering comments.

Afternoon Chair, Vice Chair, Members. DHRD stands on this written testimony. We do offer a amendment to the measure. Thank you.

Kathy Wilson individual in support.

Stand on my written testimony in support.

Thank you. Anyone else in person or on Zoom would like to testify on HB 1509 HD1? Seeing none. Members, any questions? Okay, moving on to HB2164HD1 relating to workers compensation defines compounded prescription drugs for the purposes of workers compensation law. DLIR offering support.

Hello Chair, Vice Chair and Committee Members. Jade Butay DLIR. We stand on our testimony in strong support. This measure provides a clear definition of competitive prescription drugs and helps prevent inflated pricing in the workers compensation system. Thank you for the opportunity.

Thank you. Department of Human Resources Development in opposition

Afternoon Chair, Vice Chair Members Brian Fruto, Deputy Director for DHRD we are in opposition to this measure and we offer a number of amendments to to the Bill itself, but otherwise we stand on every testimony.

Thank you. Hawaii RePack in support.

I stand on my written testimony and strong support.

Thank you. Solera Integrated Medical Solutions in support.

Good afternoon. Chair Matayoshi, Vice Chair Grandinetti and Representative Iwamoto, Representative Martin, thank you for the opportunity to testify. I'll stand on my written testimony in support. However, I wanted to point out a couple of important amendments that should be added to the Bill. One is that 503 compounding facility should be added to the definition of compound.

And while compound medication is defined in the way that it is awarded in the Bill, you know, 503A facilities and 503B facilities produce compounds. 503B facility specifically, all they can do is compound medication. They can't do anything else just because they put a they have their own NDC number. That's no different than a repackaged or relabeled Bill.

And the current statute addresses that very broadly just by saying compound. So, you know, sticking to that definition gets very limiting.

And I included in my testimony an example of such a compound medication that is labeled in accordance with FDA guidelines labeling it as a compound medication, identifying which facility compounded it and on what date it was compounded. And the second amendment we would recommend the Committee adopt is to limit physician dispensing to post 30 days of injury.

During the first 30 days, there's a little bit of a gap, and I think physician dispensing fills that gap very, very nicely. However, after the 30 days should be more than adequate time for the employer to get the injured worker set up with a PBM. Thank you for the opportunity to testify.

Thank you. Anyone else in person or on zoom would like to testify on this measure. Seeing none Members, any questions?

RePack Hawaii, can you address the 503 issue brought up?

Yes. So in my testimony, I put a picture in there because I think picture says a thousand words. It's very complex and there are people opposing this Bill that like to confuse it. So if you look prescription that is made by a compound pharmacist is a 503A and that is they have to have a prescription.

They make up the medication for one specific patient. In 2014, the FDA came out with a new type of manufacturing and it's called the 503B which is a compound manufacturing this allows medications that Big Pharma will not make because they can't put a patent on it make prescriptions that other words we wouldn't be able to have.

This is a cost saver and it makes medications available that would not be available. These medications go through the same process that a drug and a manufacturer or excuse me Big Pharma would go through.

The difference is that the FDA gives you a list of ingredients that they're allowed to make prescriptions out of and it has to be on that list. These medications are assigned a national drug code, an average wholesale price. They go through extensive testing for each batch that is not happening in a regular pharmacy which is a 503A.

We introduced this Bill to update Hawaii law to be to mirror what the federal law states and that's why we introduced this Bill.

We did not introduce this Bill to to prevent physician dispensing which has been something that we been able to do with the local payers respectfully and within the same costs as if they were to go to a pharmacy.

So why not send it to 503B as well as was recommended by the.

We're not saying that we want to specifically include 503B as it's written just as a compound drug that's causing confusion. A 503a is reimbursed per the active ingredient. There is no per active ingredient in a 503B. The drug is a finished drug product. It is not being mixed as you can see in my picture that I submitted.

The pharmacist is actually mixing it. It doesn't go through batch testing. When it's done in the manufacturing everything's sterile. It goes through FDA extensive testing. Each batch has to go through two separate tests before it can be put onto the shelf. We can only sell to hospitals, pharmacies and medical clinics. We cannot go through wholesalers or PBM type things like that.

Thank you.

Thank you.

Any other questions? Seeing none. Moving on to HB2165HD1 relating to the Hawaii Employment Security Law. Amends the qualifications for unemployed individuals who are able to receive unemployment benefits. Removes the two year limitation on the recoupment of overpayments. First up, Department of Labor and Industrial Relations in support.

Mahalo Chair, Madam Vice Chair and community Members. Jade Butay for DLIR we stand on our testimony and strong support. This measure strengthens the integrity of the UI program, improves operations and ensures compliance with federal requirements. Thank you.

Thank you. Anyone else in person or on zoom would like to testify on this measure.

Good afternoon Chair Matayoshi and Members of the Committee. I'm Joli Tokusato with Unite Here Local 5. We oppose HB 2165. We like the other Bill last year, the one trying to help striking workers receive unemployment benefits instead of this one that makes it harder for us. It's already hard to go on strike

and it's already hard to qualify to get unemployment while you're on strike. So no need this Bill, um, please. U.S. legislators should look out for workers that live here instead of the corporations and REITs. Don't take away benefits for people whose sacrifices are the main force decent for building a decent standard of living in Hawaii.

So thank you very much.

Anyone else in person or on ZOOM would like to testify. Members, any questions?

Dlir. This is kind of a small change, but one of the testifiers suggested using five business days rather than five calendar days for employers represent to report separation and wage information. Is that going to throw you guys off if we make it five business days rather than five calendar days?

They're just kind of say weekends or long weekends.

Chair, you know I brought the person who knows the ropes. So you think, um, this is Anne Pereira-Eustaquino. She's our administrator.

Good afternoon. Chair, vice chair, Members of the Committee. Anne Eustaquio, unemployment insurance administrator. So that was part of the changes that we wanted to make to this statute.

Those um days within that statute is to so that we can comply with federal regulations and peanut Windu. So we have specific requirements from USDOL on the time frame of making a payment, a timely payment to a claimant for unemployment insurance benefits.

In order to make a timely pay, there are certain milestones that we need to meet and that's why the five days was inserted in that statute.

Okay, so if we change to five business days then that would throw your timeline off because it might push you.

That's correct.

And then we were considering. I know you want kind of an unlimited clawback period, but I was kind of considering doing like a six year and right now it's two years. Just giving you more time to six years. Is it is the reason you're asking for unlimited another federal kind of conforming thing?

So if I could address what we're asking asking for. So they still. The individual who owns the overpayments from a claim where they were overpaid still is legally buying to make that payment for life. The two year clawback period is only for future offsets of unemployment insurance benefits.

So individuals who have an overpayment and then to receive benefits Again, for a new claim. And if they have an overpayment of benefits and it's past the two years, we cannot currently use the payments that are being made to the claimant to offset their overpayment from a past claim.

And so what this, that this new statute would do, it would allow us then to use the unemployment benefits that they should be receiving in the future. For any overpayment from past benefits paid, it is in line with federal regulations to be prudent in keeping the trust Fund. The integrity of the trust Fund.

Makes me a little uncomfortable because the next time they need it, they may have gotten overpaid, but that money has probably been spent if they're in that position anyway. Allowing you folks to claw back the entire payment might put someone who was already in a very precarious situation just in a hole they can't dig out of.

Can we set some kind of limit to how much you can claw back per payment? Maybe like a 10% or something reasonable to make sure that they still have something to live on when they're on unemployment, even if it is past the two year period of time.

There's lots of other ways too as well. So we have payment plans that we can put into place with claimants. We work with them to see how much they can pay, you know, on a regular basis so that we can start getting money back on that overpayment.

And so we can work if they have like an overpayment plan in place to pay back their overpayments or like a percentage.

So we could look at different variations on working with the claimant so that we can get them to make payment on that overpayment, but make sure that they can sustain themselves through the hard time of being unemployed.

It's the future UI payment though that we're talking about clawing back pretty much all of it until their debt is paid. That's what makes me a little uncomfortable, that future UI payment.

I mean, I understand they owe the state money, but you know, and if they're under a payment plan, that's fine, but it sounds like the intent of DLIR, and I'm not attributing malice to this, but the intent of DLIR is when they need UI in the future to basically keep the UI until that amount is paid back, which could put that person in a very bad situation.

So what do you think is a reasonable percentage to withhold for the clawback on future UI payments?

Wouldn't want to give you a percentage today, but I think it's something we can definitely look at, seeing what percentage would be feasible to make sure we keep the integrity of the Fund.

Make sure that claimants do know that there is this process in place that allows them to still collect benefits so they can, you know, maintain their livelihood, but still be responsible for the overpayment that they received on a past benefit claim.

I kind of want to put a percentage in there. When we decision make today on this. Is it possible for you to get me a. I guess I can push it to tomorrow. Why don't we.

I'm probably going to recommend that we insert a blank amount and maybe you guys can get back to us before we do the Committee report and we can suggest the next Committee. But again, I don't want the full amount clawed back. You know, it's a person in a very desperate situation.

Turning to UI, they probably need at least some of that money to get by. I feel like agent leave them an alert. It's just going to make things worse. Please be in contact.

Okay. And just to let you know, in order to implement this in our system, we'd have to be able to input that percentage, you know, and make sure that the system can make that calculation. And it's not just a blanket. No payment goes out. So the timing of all of this is important as well for us.

And when we implement this clawback, if we do that, and maybe if it's in alignment with our modernization project, which is coming into effect in 2027, would be in line with trying to modernize our system and make sure that we don't break what we have in place today with a really fragile mainframe that we're dealing with today and implement that percentage through our new modernized system.

Thank you.

Maybe make that clawback uh percentage clawback provision effective as of sometime in 2027 when your new system comes out.

Give us that date too. We'll put it a blank date for that as well.

That's correct, yes.

Clarifying question. This recoupment applies only in cases where the worker was at fault for the overpayment or does it.

So a determination is made whether they're at fault or not, whether that payment is due to the unemployment insurance division for many different reasons. The claimant could have misreported, the employer could have misreported. And so information that came into our office needed to be recalculated.

Okay. Okay, thank you.

And so a payment could have been changed at any time throughout their claim. We do have the ability to waive as well. So we go through that process with the claimant as well.

Actually, you know what? I think we're going to push the DM for this Bill to tomorrow, tomorrow's agenda. Can you get me the information on the percentage and the effective date by tomorrow?

Yes, I can.

And we will just put it in. I don't want to leave it to the Senate to put in if possible. Rep Iwamoto.

Thank you so much.

So regarding the Testimony from Local 5 and this is specifically regarding the labor dispute issue is so tell me how that would work in terms of for instance, I guess when the Kapiolani nurses were locked out and so they weren't able to return to work, was that considered a disputed, was that a period of dispute and so they were not able to collect unemployment insurance?

How does, how does this work in labor? Like when it's I guess union represented labor.

So when there's a labor dispute, it's not just you get benefits or not. There's lots of different requirements that have to be met in order to receive benefits while you're in the labor dispute.

And so say they were determined to be able to be eligible to receive benefits, then we would make sure that we go through all the steps to pay these individuals benefits.

Individuals under this statute that we're trying to change under these new rules, individuals who are, who belong to a union and that union is a referring union, they would not have to look for work. So it's only unions who do not have a hiring hall and are not a referring union. And it's in alignment with federal regulations.

So we recently, and you'll see the letter that Director passed out to all of you is a letter that unemployment insurance and Department of Labor received from U.S. Department of labor letting us know that we are probably not in compliance conformity with federal regulations when it comes to labor disputes.

And that's why we moving to change the statute so that we can be in compliance. Okay.

I apologize for interrupting you, but we are allowed to. We. Is our unemployment insurance, is it federally funded?

Yes.

By how much? What part of it is federally funded?

The payout is all from employer contributions. Employers that go into the trust Fund. Correct? Yeah. So if you're on the approved list with the unemployment insurance division, meaning you are a referring union, then you wouldn't have to have your individuals look for work.

Okay. And then the payout.

So the funds to administer the program is 100% friendly.

Federal regulations. Right. And so U.S. Department of labor is telling us that if we are not in compliance or conformity, we could lose 100% of our grant to run the unemployment insurance program in the state of Hawaii. Not only that, employers would also lose their FUTA credit.

Okay. But if you're not. So it's dividing. And this is based on the federal

So employers in the state of Hawaii currently, since we're under conformity, receive what we call a FUTA credit. So on the federal unemployment tax side, they normally would have to pay a 6.0% tax on taxable wages. Currently, since we're in compliance, they get a credit of 5.4%.

So they would only have to pay 0.6% on the Futa side as long as they're in compliance with state unemployment tax.

And so this document that you just shared with us, is it administrative or congressional lawmaking?

So they could change their mind next year.

That's directly from the administrator of the unemployment insurance division.

It's part of their statute. It's part of their regulations.

Oh, so it is passed through Congress.

It's part of their regulations.

Through Congress. I mean, the only reason why I'm asking because is this an act of Congress or is this an administrative thing? Because I know that the state of Hawaii is pushing back against some of the federal administration's tweaking of things that really hurt certain populations.

And in this case, that's workers.

Okay.

That's their interpretation of the regulation. I, you know, I couldn't tell you exactly, but it's, it's definitely a regulation. And this is the, I want to say, maybe a new Administration interpretation of that regulation.

Sorry.

Okay moving onto.

So, but we don't know. You can't tell us if this is one of the many cases that the state, our state AG is signed on to. I could not touch back against some of this interpretation. But we don't know that. I don't. Okay, thank you.

Yeah.

Thank you. Moving on to HB 2367 relating to employment earnings. Requires hourly rate or salary ranges to be disclosed on job listings for full time, part time, temporary or seasonal employees. Removes the exemption for employers having fewer than 50 employees. Hawaii Civil Rights Commission in support on zoom.

Good afternoon, Chair, vice chair, Members of the Committee, Constance Yonashiro for the Hawaii Civil Rights Commission. We stand on our written testimony in strong support of this Bill and appreciate the clarity that it brings. Paid transparency prevents hidden disparities, builds trust and a step towards pay equity in Hawaii. Thank you for the opportunity to testify.

Thank you. AAUW of Hawaii in support.

Good afternoon, Chair, Vice Chair and Members of Committee. I'm Younghee Overly from AAUW and we stand on our written testimony in strong support. I do want to also share with you and emphasize element of this so pay transparency was a good tool that I had as a manager 20 some years ago.

It was considered a good tool by baby boomers like me and Gen X's. Today the millennials and Gen X expect this. It's not. It's just a good tool. They expect it. They expect pay transparency.

So I do want to highlight recent study done by PayScale as well as Society for Human Resource Management that indicates that and in fact 82% of people who apply are more likely to apply for the job if there is a pay range that's posted with them.

So one of the arguments you're going to hear is that this will be additional burden to small businesses and if Sandy Ma who's also on AAU team was here, she'll tell you that her family has Chinese restaurant and they know exactly what they're going to pay their employees that this is not additional burden other than just writing it down as part of japost.

So thank you for listening and please pass this major thank you.

NFIV Hawaii Chapter in Opposition Not Present. Hawaii Women Lawyers in Support on Zoom Not Present. Fujiwara and Rosenbaum LLC in Support on Zoom. Jean Evans in Individual in Support

Good afternoon Chair Vice Chair Community Members. My name is Jean Evans. I retired after 40 years working for non profit organizations here in Hawaii and you have my written testimony. It's a place I just want to make a couple points.

I most of my time was in Executive positions and I did hold two Executive Director positions over those years. The first time I applied I didn't know what the salary was. It wasn't posted. I asked and they said oh, it's negotiable. And they offered me a salary that I thought was pretty good.

It was more than what I was making. So I was pretty happy until just a few weeks later when I was on the job, I found out that my predecessor was making twice over twice what I was making.

I was really upset, I felt betrayed, I felt really stupid and embarrassed for being so naive and I started looking for another job. And then on the other hand I've interviewed hundreds of people over the years and you know, it wasn't done. I knew how much we could pay.

Especially in nonprofit you got a budget, you know, you can't go over that. But we didn't post it. One more thing to have to do. And so I ended up wasting my time and time from many applicants who wouldn't work for what I could pay. So I Just think it's really important that we make this open.

You know, employers are always going to grumble. I certainly did when there was any requirement, new requirement. But after a short while, after official nudge to do it, most of the changes made really turned out pretty good. It was either for improvement in health and wellness and employee satisfaction and fairness.

So I really do encourage you to support this. Thank you.

Thank you. Anyone else in person or on Zoom who would like to testify on this measure? Okay. Also noting 11 individuals who support who submitted written testimony and support Members. Any questions? Seeing none.

Moving on to HB 2619 HD1, relating to homemade food products requires the Department of Health to adopt rules for the regulation of farm kitchens producing homemade food products that are no more stringent than those for home kitchens producing homemade food products. Department of Health Offering comments

Good afternoon Chair, Vice Chair, Members of the Committee Matt Carrano, Department of Health Environmental Health Services Division we stand on our written comments largely in support of the intent of being treating your farm kitchens and home kitchens equally.

We do have an offered amendment that almost restores it to the original version when it comes to a definition of homemade food products if it's defined in the statute and locks us in its rule.

And in the future, if we ever wanted to broaden it, which I think the industry would actually prefer, it's going to potentially prohibit that or make it more complicated. So we'd hope that the offered amendment helps and provides some clarity and gives us some flexibility in the future with rulemaking. Available for comments. Thank you. Questions thank you.

Hawaii Food Industry Association in support not present, Grassroots Institute of Hawaii and support not present. Okay, anyone else in person or on Zoom would like to testify on this measure? Seeing none, Members, any questions?

Moving on to HB 1765 HD1 relating to spear phishing safety establishes safety warning requirements regarding spear phishing and requires safety warning to be displayed beginning 7/1/2027, Department of Land and Natural Resources offering comments.

Good afternoon Chair, Vice Chair and Committee Members David Sakota for DLNR Division of Aquatic Resources. We'll stand on our written testimony appreciating the intent of this measure and offering comments and available for questions.

Thank you. Freedive Safe Hawaii in support on Zoom.

Hello Vice Chair and Members. I've spent years providing free spearfishing safety education statewide thousands of divers, countless families across Hawaii. From that experience, I know that many parents and new divers don't learn about hypoxic blackout until after that diving. That's when they reach us. That knowledge gap is real.

And it's exactly why a warning label is not necessary. A label alone won't solve the problem. This Bill doesn't expect it to. It's one layer in a prevention strategy alongside education and community outreach. But it guarantees that every first time buyer sees a clear warning at the moment it matters most.

That is concrete, evidence informed way to reduce preventable deaths. As for burden, the label costs less than 30 cents on $100 pole spear or $300 spear gun. It's minimal, targeted and standardized, simple to implement. Many out of state manufacturers are used to following state labeling rules.

So this adds no unexpected burden and we want to make sure our local manufacturers and retailers are supported. This is a low cost, easy to implement step that works for everyone. And this is not an unnecessary cost. It's a reasonable safety measure that informs our ocean community. Public health shows layered approaches work better than single interventions.

Combining education with clear labeling improves public safety. And that is exactly the intention of this measure. Thank you.

Thank you Hawaiian Lifeguard Association in support on Zoom. Hawaii Lifeguard Association

I'm here. It just wasn't coming up. Aloha everyone. My name is Kirsten Hermstead. I'm the Executive Director of the Hawaiian Lifeguard Association. I stand on our written testimony in support of this Bill.

In summary, my letter offers a reminder that spearfishing is recognized as a significant cultural substance practice and that Native Hawaiians and Pacific Islanders die from drowning at a higher rate than any other ethnicity in Hawaii partly because of these cultural activities. And that multiple studies show that warning signs and messaging work, particularly in aquatic environments. Thank you.

Thank you. Anyone else in person or on Zoom would like to testify on this measure? Seeing none, noting an additional 17 individuals who submitted testimony in support, and two in opposition Members. Any questions? rep Iwamonot.

Thank you for the testifier on Zoom who just cited other, I mean, I guess studies that have shown that labeling works because that was my first question. So are there other states that have enacted a similar similar law that we've seen like a reduction in deaths because of this labeling?

I think that the that question should be probably directed towards Nikki. If it is free diving specific. I'm unaware of freediving specific language. However, there is Consumer Protection Safety Commission studies and other journal of Research and education that identify that this type of warning and signage is very valuable and does save lives.

But I'll defer to Niki on specifics about spear driving initiatives.

There is currently no labeling worldwide on spearfishing or freediving equipment.

Okay, yeah, that was my question, I guess is there's so nowhere anywhere in the world or in any other state is there this labeling requirement. So we have nothing to say that this labeling does actually save lives.

Consumer labeling is proven through the research that it was stated by Kirsten to be effective at alerting consumers to known risks associated with the activities of the equipment that they're purchasing.

Okay. So it just. I guess I'm confused because I just heard that the culture and practice of Native Hawaiians and Polynesians who are, who've been practicing diving for generations, that they have the highest rates of death.

So I guess I'm having a hard time believing that they're experienced divers where they learned this passed on and they're still dying. But this label will keep them from dying. I don't know. Is that.

May I respond to that?

Yes.

We know now there's a wonderful study that I can put into the chat or send to you guys later by John Kalei Clark about Native Hawaiians and Pacific Islanders drowning at higher rates than other ethnicities. And there seems to be a gap, a generational gap in passing down the knowledge.

Additionally, most of the messaging that we do here in Hawaii, and I'm not being critical, is visitor specific. Right. Recreation specific. But there's very little messaging that's directed towards cultural practices.

And so many kids get in the water and they've not had any training before they get in the water or, you know, young adults, I don't mean children.

They're not spearfishing, but young adults who are taking up spearfishing may be getting in the water without any knowledge other than, hey, my aunt and uncle do this, going to go do it. And they may not be aware of the risks.

So it's an equity issue and it's something that we at the Hawaiian Lifeguard Association are working very hard to fix through very specific cultural education opportunities. Thank you.

Thank you. Members. Any other questions? Okay, seeing none. Moving on to HB2187HD1 relating to healthcare. Prohibits healthcare facilities, healthcare providers and emergency medical services from furnishing medical debt to a consumer credit reporting agency. Prohibits consumer credit reporting agencies from reporting or maintaining medical debt information in the file on a consumer State Health Planning and Development Agency in support.

Chair Vice Chair Members, Jack Lewin from SHPDA. We certainly and strongly support that individuals not be penalized on their credit reports for seeking medically necessary care. We did move on in our testimony to talk more about why we shouldn't have medical debt at all in this country.

But that's really a little bit off topic here, but thank you for supporting this Bill.

Thank you. Hawaii Public Health Institute in support not present. Consumer Data Industry Association in opposition on zoom.

Vice Chair Committee Members Chris Delaney with SanHi Government Strategies here on behalf of the Consumer Data Industry Association. I'm not going to go into much details. You have our testimony. But we're in opposition of this Bill due to federal preemption concerns under the Fair Credit Reporting Act.

There are a number of cases in Texas, Minnesota and Maine challenging new state laws that ban both furnishing and reporting medical debt. And I'm here to answer any questions. Thank you for this opportunity. Appreciate it.

Thank you. Aloha Care in support on Zoom. Not present. Okay. Anyone else in person or on Zoom would like to testify on this measure? Seeing none. Members, any questions?

I have a question, actually for SHPDA.

Do you have concerns over the federal preemption or do the language in the Bill?

Over the federal preemption. Yes, we have concerns about the federal preemption. We'd like to. This is a step in the right direction. If we just work in Hawaii to make sure that we don't report to credit the credit reports, we have to defer to the AG in terms of what the legal ramifications that would be.

But it shouldn't be that hard to say that in Hawaii we're not going to contribute to people's credit reports for getting seeking essential medical care.

Thank you. Members, any other questions? Seeing none, moving on to HB 1864 HD 1, relating to insurance. For policies, contracts, plans, and agreements issued or renewed after December 31, 2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically-necessary treatment that may cause iatrogenic infertility. DCCA Insurance Division, in support.

Good afternoon, Chair, Vice Chair, members of the committee. I'm Justin Chu with the Insurance Division. We stand on our written testimony in support of the measure and provide comments. Thank you.

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

Thank you, Chair, Vice Chair, and members. Jack Lewin of SHPDA. We strongly support this standard of care on the mainland. It should be here for women of childbearing age who undergo medical care that may cause iatrogenic infertility. I would say our testimony is a little wrong.

It's the previous testimony uploaded and we want to acknowledge that HD 1 removed that age 26 and said, you know, it allows all women to be covered, so we appreciate that. Thank you.

Thank you. Hawaii Association of Health Plans, in support.

Good afternoon, Chair, Vice Chair, and members of the committee. Rachel Wilkinson, on behalf of the Hawaii Association of Health Plans, in support. Our member organizations recognize the importance of this issue and we just want to support the Legislature's efforts to ensure that these services are accessible to individuals undergoing treatments that may result in infertility. Thank you.

Thank you. HMSA, in support.

Chair Matayoshi, Vice Chair Grandinetti, and members of the committee, Walden Au, on behalf of HMSA, and thank you for the opportunity to provide testimony in support of House Bill 1864. We appreciate, you know, following the auditor study in 2311, all of the stakeholders coming together to find a path forward. Thank you.

Thank you. Anyone else in person or on Zoom that would like to testify on this measure? Seeing none. Members, any questions? Rep. Iwamoto.

I'm sorry. I have a question. Perhaps for SHPDA. Sorry. So this bill would cover or would make it, I guess, mandatory that insurance companies cover the retrieval process but does not cover storage? Is that the way I'm reading it? Is that how I'm reading it?

Well, I think the storage is-- our understanding is the storage would be covered, but that's a good question to be clarified.

Okay. I thought I saw specifically does not include storage, which then opened up, what happens if they remove it and somebody doesn't have the money to store it? You did this procedure to what end?

That becomes discriminatory based on income, which is not appropriate and-- for this kind of service, so we will check on that and get back to you.

Oh, okay. Thanks.

Any other questions?

Having gone through the storage is not that bad, so. I do have a question for-- it could be HMSA. I'm just wondering--or if not, if Walden, if you don't have the answer, then maybe we can ask someone else--but what would the increase be for health insurers for this bill? I mean, how many people are we talking about? What kind of cost do you anticipate?

Yeah, thank you for the question. We had looked back at the study and the responses that were provided and I think just the nature of how broadly written the bill was at the time.

The bill has morphed a little bit since then. I believe the 2311 study was related to infertility caused by cancer. This is for iatrogenic infertility. The numbers that were pulled in terms of requests for the fertility preservation services was relatively low, but numbers related to chemotherapy and cancer-related services were fairly high.

So at that time, we weren't able to necessarily get a very clear cost impact analysis done partly due to our-- largely due in part because of how small of a window we had to respond to the auditor.

We'd be happy to come back with you with figures, but again, there is some questions as to kind of a chicken and the egg, right? It wasn't necessarily widely, I guess, sought after, but should it be covered? Will there be an increase for that service?

Okay, so do you have any--

So because of the numbers that were requested, it didn't seem like a large amount that it would impact our premiums--

Are we talking about like tens or hundreds or thousands a year? I mean, what's the range of-- that you anticipate?

I mean, in terms of the amount of requests for services, it was very, very low for the years that we pulled. I believe that was for '21 and '22. But again, though, if this is mandated, will more people see? That's the question.

How much per person is it about for these services?

That, I'd have to look back at the study, and also things have changed quite a bit since '23, but based off of our feedback from that, as well as the work with the other stakeholders, I mean, we felt that this was an important issue to get by.

Okay. Someone from the Insurance Commissioner's Office here? So in your testimony, you were concerned that it would, I guess, trigger 45 CFR 155-170. Have other bills we've passed, that the Legislature's passed in the past that have conferred certain or mandated certain benefits from health plans, have they triggered this provision? Have there been any that we've passed that have not triggered this provision?

Yeah. So currently, the state does not pay any defrayals for mandated benefits. CMS, the Center for Medicaid and Medicare Services, makes a list of measures that they do think are in addition, but so far, there's no defrayal payments being made.

So it's certainly not a guarantee that it's--

--this bill?

It's not a guarantee.

That's correct. Yeah. I'm sorry, I interrupted you. I didn't hear the rest of your question. It's not a guarantee that--?

It's not a guarantee that this provision would be triggered and the state would have to pay?

That's correct. It's not a guarantee. However, we do note that in the most recent notice of benefit impediment parameters, which is CMS's yearly, like, administrative rule-making process, they issue new rules every year and they propose these new rules to the NPPE.

So the current administration is a little bit more interested in enforcing state defrayal requirements and they just noted that-- so typically if a benefit is in our EHB plan, which is the benchmark plan, that even if there's a state mandate and it's already in the plan, then there's no state defrayal. However, according to these new rules, if a benefit is in the benchmark plan and the state does mandate it, then they would consider it in addition to--

And when did those new rules kick in?

It would be for plan year '27.

Okay.

But again, those are proposed rules, and so, comment and--

Is it retroactive too? Could that affect other things we passed in the past?

I don't believe so, but I'd have to double-check that.

Thank you. Thank you.

Yeah, sure.

Members, any other questions? Seeing none, moving on to--

Chair, do you mind if I ask a question of the Association of Health Plans?

Sure.

Testify, I think-- so you testified in support of this bill, and would your support change if, on the line on page three, line 20, where it says any services related to cryopreservation storage, which is identified as that standard fertility preservation services does not include storage, so would it change if it did include storage?

Thank you for that question. We'd have to take it back to our members to discuss.

Thanks.

Thank you. Moving on to HB 1452, HD 1, relating to birth certificates. Includes advanced practice registered nurses among the types of healthcare providers who can submit an affidavit for a new certificate of birth for certain birth registrants. Hawaii Health and Harm Reduction Center, in support, on zoom. Not present. Pride at Work Hawaii, in support on Zoom.

Good afternoon, Michael Golojuch, Jr., he/him pronouns. I'm President of Pride to Work Hawaii. We stand in strong support of this legislation.

All we're asking for here is to be able to—all this Bill does is ask for APRNs to be added to the list to add to their myriad of already legislated actions that they're able to do. Without this, it would—given the status of our health care system here, it denies citizens their ability to access their, their ability to amend their birth certificates as this body has already done many years ago.

So, we encourage you to pass this law, give the access they—that our, our, our members need. Our ohana, our family members need. Nothing—given what's happening in the world today, that they, this is def—desperately—needed for so many people.

So, we encourage you to pass this law. Thank you. Mahalo.

Thank you. Hoku Pack, in support, on zoom. Not present. Stonewall Caucus of the Democratic Party of Hawaii in support on zoom.

Not present.

Shonda Brack, individual in support. Rick Ramirez, individual in support.

Hi. Good afternoon to the Committee Chairs, Vice Chair, and Committee Members. Thanks for hearing on this testimony. My name is Rick Ramirez. I am a doctorally prepared nurse practitioner. I am also the gender-affirming care provider at Hawaii Health and Harm Reduction Center.

I just want to point out that this is not changing anything of the already established law except for adding in nurse practitioners to the language. Nurse practitioners have had authority for full practice authority since 1995 in the state of Hawaii.

And when nurse practitioners are left out of legislation such as this, then they cannot perform the actions that are bestowed upon them with that full practice authority. Many patients are seen by nurse practitioners solely.

And so, with the elimination of nurse practitioners from the language, then a patient who is requesting the service then has to establish a new relationship with a physician or physician assistant, which increases healthcare costs and increases stress and burden on the patient.

So, we're just asking that the addition of nurse practitioners be added so that we can fill out this paperwork for patients who are requesting it, without the additional stress or increase in workload on the other factors within the healthcare system. Thank you and I appreciate your support.

Thank you. Anyone else in person or on Zoom would like to testify on this measure? Noting an additional 12 individuals who submitted testimony in support. Members, any questions? Okay.

Seeing none. Moving on to HB 2314 HD 1, relating to emergency medical systems of care; modernizes Hawaii's emergency medical services laws to align with current best practices. University of Hawaii, in support on Zoom.

Good afternoon, Chair, Vice Chair, and committee members. Yep, this is Karen Boyer, on behalf of the University of Hawaii Community College System. We writ-- we stand in support of our written testimony. Thank you.

Thank you. Department of Health, in support.

Good afternoon, Chair, Vice Chair, committee members. Garrett Hall, Chief of EMS for the Department of Health. We stand on our written testimony in support and I'm here to answer any questions you may have.

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

Chair, Vice Chair, and members, we stand in strong support. Stand on our testimony.

Thank you. Anyone else in person or on Zoom who would like to testify on HB 2314 HD 1? Seeing none. Members, any questions?

Moving on to HB 1898 HD 1, relating to health; clarifies that the Department of Health is to presume both the recommendations by the American Academy of Pediatrics and the recommendations by the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services--wait--that they constitute the prevailing medical--sorry about that--prevailing medical standard for child health supervision services for purposes of health insurance coverage. DCCA Insurance Division, offering comments.

Good afternoon, Chair, Vice Chair, and members of the committee. Justin Chu from the DCCA Insurance Division. We stand on our written testimony, providing comments. Thank you.

Thank you. Department of the Attorney General, offering comments.

Good afternoon, Chair, Vice Chair, and members of the committee. My name is Deputy Attorney General Kyna McCallin, and I'm here on behalf of the Department of the Attorney General. We just provide the following comments. We note that the bill uses a clear and convincing evidentiary standard that the Department of Health must follow in order to deviate from the prevailing medical standard.

We note that that is a legal standard that's not easily translated into a non-legal setting. We also note that the bill does not define Department as Department of Health and that it amends the plural-- the current plural prevailing medical standards to a singular prevailing medical standard. As such, we offer amendments on page 2 of our testimony, and I'm available for any questions. Thank you.

Thank you. Department of Health Disease Outbreak Control Division, offering comments.

Good afternoon, Chair, Vice Chair, and members of the committee. Sarah Kemble, Chief of the Disease Outbreak Control Division for Department of Health. We greatly appreciate and support the intent of this measure to protect children and families by preserving access to preventive services. We do offer some amendments which we think will further the intent of the measure, and we stand on our written testimony; stand by for questions.

Thank you. SHPDA, in support.

Thank you, Chair, Vice Chair, members. We stand in support and echo the Department of Health's testimony.

Thank you. HMSA, offering comments.

Chair, Vice Chair, members of the committee, Walden Au, on behalf of HMSA. We recognize the challenges created by the current federal administration when it comes to access to things like immunizations and vaccines.

In 2025, in fact, HMSA broadened our recommendations beyond the ACIP to include but not limited to the Hawaii Department of Health and the American Academy of Pediatrics. While we appreciate the intent of the measure, similarly to some of the other points, we feel that it might create some confusion, but we look forward to continuing to work with the Department of Health and the Legislature in trying to ensure that this access is available for people who need it. Thank you.

Thank you. Cheryl Toyofuku, individual in opposition.

Aloha, Chair and representatives of the CPC Committee. My name is Cheryl Toyofuku, and I'm a mom, I'm a grandmother, I'm a retired registered nurse, and I'm a health advocate. Thirty years ago, I did transition to my natural, non-toxic healthcare, and I'm in strong opposition to HB 1898.

It clarifies that the Department of Health is to pursue the recommendations of the American Academy of Pediatrics, AAP, and the ACIP, which is the Advisory Committee for Immunization Practices, and it's to constitute the prevailing medical standards for childhood-- child health supervision in healthcare coverage.

You know, you might realize that many Hawaii families and parents now are very questioning some of the recommendations from their pediatricians, which we go every-- you know, at each visit it's another vaccination. I'm a grandma, so I remember getting three, then my daughter maybe a little bit more, but now they get about 70-something doses of 16 different vaccines.

And I did submit my written testimony with links about vaccine research and clinical data. You know, this bill focuses specifically on the full range of prevailing medical standards, especially childhood vaccines, and since we're questioning-- and, you know, the parents are not given fully informed consent as to the vaccine ingredients, to the benefits and the risks of vaccinations.

It has been shown by research--and you can follow the link, or I have some written handouts if you would like--they've been shown not to be safe and infected many times, and yet, this has been the narrative of the American Academy of Pediatrics. So as lawmakers in this Consumer Protection Committee, we just ask that you please do your research on vaccines.

Again, and note that-- please note that the American Academy of Pediatrics has recently been hit by a lawsuit due to fraudulent vaccine safety claims. So over the many years, we also have concerns over the Advisory Committee on Immunization Practices. This has been-- over the years, there's been concern as to the recommendations.

I don't think I need to go through many of the myocarditis and the terrible cancers that have been affecting many of our families because of vaccines and for insurance coverage to focus on the vaccinations when it's not covering many of our other more natural, non-toxic type of health remedies that we are trying to keep our immune system strong. So it just seems that this is an unnecessary bill, so I ask that you please oppose it. Thank you.

Thank you. Anyone else in person or on Zoom who would like to testify on this measure? Okay. Seeing none. Members, any questions?

I have a question for HMSA. So, noting the concern about confusion with the two separate recommendations, I assume you read the Department of Health testimony?

We didn't get through the testimony, Chair, but we did--

Did we simply suggested that they would pick a recommendation? Would that be clear enough for you folks?

I believe it should be. We were also told that Senate Bill 3133 is kind of a overarching, I guess, vehicle for some of these preventative health-related coverages. So we'll definitely take a look at the department's testimony and-- I mean, we appreciate that if the bill continues to move forward that there will be continued dialogue with it, so.

Thank you.

Any other questions, members?

Thank you. I think this may be for SHPDA. Is that-- yes. This is kind of your bill or no? I'm sorry. Which agency is--

Yeah. Department of Health.

Department of Health. Sorry. Sorry about that. Sorry, wrong person. So regarding the-- so right now, are all vaccinations covered by health insurance?

So right now, the vaccines that were previously recommended by the Advisory Committee on Immunization Practices have been covered and continue to be covered by all of our local insurers and by most national insurers. This language would preserve that into the future by maintaining access to those vaccines that continue to be supported by medical evidence as recommended.

Okay. But then it also says that if, for instance, what we're seeing now on the federal level, some vaccines may be dropped off the recommendation, but if the Pediatric Association says this one is good, then the insurance companies should cover it as well?

So if there's a contradiction as there is today between CDC or ACIP recommendations and the AAP recommendations, the Director of Health may recommend which standard should be the prevailing medical standard. So that would allow to follow the more comprehensive recommendation for what should be covered without cost-sharing.

Okay. And again, it's ol-- okay. Got it. Thank you. So I'm-- just to be clear, it's just making sure there's more support, more choices for--

Exactly.

--families?

So it's preserving the choice to get all of those recommendations that are based on the medical evidence, even if national federal recommendations are moving away from that.

Any other questions? Seeing none, moving on to HB2558HD1 relating to telehealth. Authorizes out of state physicians who are licensed and in good standing in the state in which they reside to provide telemedicine services in Hawaii via telehealth under certain conditions.

Clarifies that a physician patient relationship may be established with an out of state physician via telehealth under certain circumstances. DCCA Hawaii Medical Board offering comments.

Good afternoon Chair, Vice Chair and Committee Members. My name is.

Thank you. SHPDA in support.

Chair, Vice Chair, Members, we just offer one comment. We think that one element of this Bill, which is requiring supervision of the telemedicine physician by Hawaii local physicians physician is an unrealistic request, could be a barrier.

First of all it could be a liability risk but also we just don't think it's necessary in most circumstances, particularly if a patient goes is sent to the mainland to see a specialist under a circumstance that we don't have available here.

That specialist ought to be able to tell medicine consult, put that patient back to in Hawaii, follow up with them and having a supervisory doctor in that case makes no sense to us. Thank you.

Thank you. HMSA in opposition.

Aloha Chair, Vice chair and Members of the Committee with HMSA providing comments. HMSA has definitely been a long supporter of telehealth as an employee important tool to expand access to care especially for our neighbor island community and rural community Members. However, as telehealth expands it is extremely important that patient safety, quality of care and accountability remain intact.

So we appreciate the intent of this measure, but there are a lot of complexities embedded within how the Bill is currently drafted. There's lacking sufficient clarity around what does a supervising physician mean, what are the requirements?

Is a supervising physician as an example required to be actually physically present as well as there's not guardrails in place to ensure that quality of care is met? So by removing the requirement that these physicians get a Hawaii medical license, it really limits our state's ability to provide oversight and ensure accountability.

Furthermore, there's also language in there that talks about that this should only apply when there's a physician shortage or a lack of resources that is very broad and undefined. And so we are concerned that that could lead to inconsistent application by our providers as well as the insurers.

So for these reasons we are respectfully requesting that this Bill be deferred so that all the stakeholders can come together and collaborate on a solution that's going to better balance telehealth expansion while ensuring patient safety. Thank you.

Thank you, Grassroots Institute of Hawaii in support. Not Present. Hawaiian Islands Republican Women in support on Zoom.

Aloha Chair, Vice Chair and Members of the Committee Jamie Detwiler Hawaiian Islands Republican Women thank you for the opportunity to testify in support of HB2555A HD1 for the following reasons.

Allowing Hawaii residents to access telehealth from qualifying out of state providers to could help address healthcare access and staffing shortages, especially in rural and underserved areas, specialty care providers are highly sought after, which often leads to longer wait times and postponed treatment. And I just wanted to share a couple of personal stories of family Members.

I have a cousin in Puna, they live in a rural area on Hawaii island and, and it was difficult for them to access specialty care and they waited a long time for that care and the appropriate provider which delayed their treatment. So I have a number of personal stories.

I even have an uncle here on Oahu who had to wait for an oncologist delaying his evaluation and treatment for cancer. So these really, these situations affect families.

And as far as concerns that were previously expressed regarding licensure supervision, I believe there's a way to work it out because, you know, physicians on the mainland are credentialed and licensed in their respective states.

Many times, you know, insurance, for example, if you have a Blue Cross Blue Shield from another state, but the individual is in our state, you know, they're, they're billing providers here in, in the state of Hawaii.

So in reality, if those providers have proper credentialing and licensure in their respective states, I don't see where they would need, there would be a requirement for this supervision. So that wouldn't be a roadblock to accessing care. It's all about access to care. Thank you for this opportunity to testify. Mahalo.

Thank you. Steven Drapkin, Individual in support.

Good afternoon, chair, Vice chair and Committee Members. I'm Steven Drapkin. I'm a retiree. I'm 75 years old and I live full time on the North Shore of Kauai. This Bill is one of those rare bipartisan bills. Six Democrats, five Republicans who joined together in this.

And in my perspective on a subject I'm very interested in, this Bill, cut to its core is a no brainer. I'd like to address a few points that have been made and highlight my own testimony. I think I can boil it down to 7 or 8 points.

1st HRS 453.1.2 and key legislative history I uncovered from 2009 shows that section subsection F clearly allows for the use of interstate telehealth with respect to ongoing relationships. You can't use it to establish care, but you can once care has otherwise been properly established. And I see there's should be no question about that.

I do have a memo to myself I did several months ago. If the Committee is interested, I could provide you a copy of that. But you know, that's only if there's any question as to what the law currently provides.

I Want to emphasize that no matter what transpires with this Bill, if a Bill is passed, I request that there be absolutely clarifying language as to what the existing Bill means as defined exactly 17 years ago. And that's sort of at the outset.

If I can ask you to wrap up your remarks.

Okay. Real quick if I can. The Interstate Medical Licensure Compact is a non factor at this point because neither California nor New York participate in that. So the two largest states with practitioners not available. The most important aspect or thing to look at would be the COVID proclamations.

Governor Ige waived the requirement of in state doctor to establish care and there was no problem that ensued from that. Thank you. Conditions are suggestive of something that should be followed by. And I ask you to thoroughly review my testimony. Thank you so much.

Anyone else in person or on Zoom would like to testify on this measure? Okay. Also noting an additional 22 individuals who submitted testimony in support and three in opposition. Members, any questions? Rep Iwamoto.

Thank you now for SHPDA. I think in your testimony you suggested removing the supervision requirement. And yet your testimony seemed to. It seemed like it was very narrowly applicated.

The anecdote you used seemed like this would be used in the cases where there's a specialist on the mainland on the continent and they're working with a team of medical people here locally and it's a way to bring their voice into the solution or the care.

But it feels like a lot of other testimony felt pretty broad, like we're going to open things and now there's no way that we can have supervision. So I'm just wondering is there a way to make this work with supervision so that we're making sure there's compliance with our laws, Making sure that somebody's held accountable.

Feels really hard to hold somebody accountable when they don't have any kind of local ties. How do you. How would we have that if we take your recommendation, which is to remove supervision.

Thank you for your question, Representative Iwamoto. We strongly support the Bill. We want to see it happen. We just think the supervision clause 8D is going to be turn out to be a barrier in actual implementation. But we think it's a great Bill. The supervising part is a bit awkward.

It's not part of the way the state compact worked in the past. It'd be a change and we're thinking it may defeat the purpose of the Bill.

As far as the supervision goes, what exactly are they supervising?

How the Bill was pitched to me, I guess was that people were having to fly to the mainland to establish a doctor patient relationship, which didn't really involve much of anything except sitting across from the table for a doctor and talking with them, maybe sharing some medical records or whatnot.

And that's the kind of expense that we're trying to minimize through this Bill where instead of me flying up to see Dr. Lewin in California and having to get a hotel room and all the travel expenses and all that, just to sit down with them, takes me as a patient and then I fly back home to be able to just have a zoom chat with that doctor instead.

In that case, what kind of supervision would actually be needed? Is that doctor in California going to be ordering diagnostic tests prior to the meeting or prescriptions prior to the meeting or anything like that? I mean, is there anything for a doctor to oversee?

If there's just simply following up with their patient to see how they're doing or.

I thought that this was just for that kind of initial consultation, not for ongoing care between a doctor on the main line and someone here, not for any kind of treatment operations, anything like that. I thought it was just to have that initial contact.

I think the. I mean, the ideal situation for us here is to be able to have a specialist telemedicine consult while the patient remains in Hawaii, rather than having to go to the mainland in the first place, in which case there may want to be. We'd want to have a treating physician here who's a participant in that.

I'm not sure if they're supervising, but certainly a participant in care with the patient. But maybe I'm misunderstanding some of the intent here, but I think that that supervisory piece is going to be a complicated element. If we're expecting that to be any kind of ongoing relationship, care relationship with the patient.

Yeah, it could be me that's misunderstanding it too. If it is how you're saying, which is kind of an ongoing doctor patient relationship with the doctor supervising care that the patient here is going through, then you're right.

I mean, you would need a doctor here to be ordering the prescriptions and actually practicing the medicine here under the supervision of the person on the main line. But in that case, I'd assume that the doctor here would essentially be supervising and signing off. I mean, you know, they're not their employee primary.

You can't just order a doctor here to do something. Right so.

The weird instance that we're thinking about here is where you can't get the specialist visit here. You had to go to the mainland to get the care that you wanted, and you've returned back, you can do some. The treating physician can do follow-up visits.

But I agree with back to the statement, if the physician's ordering services here, then that that isn't going to be appropriate. That would fit within our licensing lawsuit.

I completely agree. And in that case they would be necessarily using. Going through a physician here, which kind of sounds like a supervising. I mean I know the supervising word might be

They're not supervising the doctor on the mainland. They're taking care.

Supervising.

They're assuming the primary treatment role here.

But they would be supervising the care. I mean they'd have to essentially be signing off by. Agreed. Yeah.

It's just a little weird that it looks like they're supervising the doctor on the mainland if they continue in their consultation role.

Understandable. But I mean, you know, egos aside, it just seems like a supervision word. It is essentially them overseeing the care anyway because they're going to have to do it right?

The primary physician.

So that oversight is still going to be there no matter what because they are going to have to agree to do it. Right.

I'm just wondering why. It seems like a lot's being made of the supervision provision, but it seems like it has to sort of be that way unless the person is going to be flying up to the mainland for all of the procedures anyway, in which case who cares because there's not going to be a local guy anyway. So seems like a moot point.

We thought it was kind of a maybe and perhaps I'm. We're misinterpreting it slightly. On the other hand, it sounds like there's a supervisory role between the two doctors which is not. That's going to be difficult in the case of the treating physician.

Switching to the treating physician here, that isn't the supervisory role, that's a new treating physician. And the other doctor could be advising but not ordering tests.

Yeah, that's fair. Thank you.

Can I ask a clarifying question actually for SHPDA? So if I'm reading the test, if I'm understanding the testimony correctly, the HD 1, the language around supervision kind of creates a relationship that's similar to the existing mechanism to provide out of state consultation. Is that correct?

We already have a mechanism for out of state consultation and by adding the supervising language it sort of.

We think that's complicated.

Can you explain to me the difference between the existing mechanism for consultation and the original language of this Bill? They're trying to provide different services or.

Well, I think that, you know, theoretically, the patient who chooses to go to the mainland to see a physician there, they're under the law of that state and they're abiding by those conditions. When they return here, they're abiding under the law of this state.

So if there's an ongoing relationship, this Bill intends to have somebody here as supervising that interaction. If the mainland doctor continues to participate, if they're not licensed in Hawaii, they can't order tests, or do. They certainly advise. But there's a bit of a complication in terms of medical malpractice associations that I think could be.

I don't think we want to barrier this to create a barrier for patients who can't see, who can't get services here. We have terrific services. There are very few times you really have to go to the mainland. These kinds of services.

People go frequently when they don't need to because they don't understand the quality of care that we have here locally. But when there is a circumstance this could arise, and perhaps we need a few smart lawyers to help interpret this in a more effective way. From my point of view.

Excuse me, may I speak to the supervision point for 60 seconds?

I'll give you 20.

I'll give you four reasons. Supervision in this context is catch 22. Because if there's no doctors reasonably available to help the patient on a timely basis, where is the doctor going to come from to supervise?

Number two, who on the mainland has been accepting, quote, supervised by somebody else here who maybe a generalist, doesn't know anything.

We understand the point. I think it's the word supervision that people are getting caught up on. And I understand. I've got a bunch of doctors in my family. They certainly got egos. And maybe the word supervision is going to be changed. I do have a question for another testifier, if you could move on. Thank you. Board.

The board of medicine or medical board, please. So my understanding again, and you heard me speaking with Jack a little earlier, my understanding of this Bill was to just have that initial consultation be telehealth for the initial consultation.

I mean, let's just take a fairly common situation that I hear is for cancer treatment that someone doesn't have the.

They can't find a specialist here that can treat them, so they're going to go consult with a mainline physician for some kind of special specialty that we don't have here for those initial consultation meetings, that kind of first meeting across the table.

Is it ever the case that that doctor would want diagnostic tests or procedures or have the patient on some kind of prescription to test them out before that meeting or is there is that meeting really just the initial meeting and they normally don't order tests prior to it?

Well, initial Bill introduced removed that 453.2.4 consultant consulting with local physicians. So the initial Bill gave full access to mainland out of state physicians can do telehealth without having any restriction or license.

So and that does make me uncomfortable but the situation that I just described for that initial meeting maybe ignore the Bill for a little bit. This is just the situation that I was told the Bill was supposed to be addressing for that kind of situation. Are diagnostic tests ever ordered prior to that meeting?

I think my understanding for the initial Bill was because it's costing too much money for the patients to go to mail in so they want to pass that Bill so they can just have a mainland doctors available through the telehealth. So it didn't say anything about initial or after meetings.

Yeah, it made it sounds like a continuous regard from this first to the last step.

Yeah, I agree that that is what the Bill sounds like. And talking to the bill's introducer that was kind of the situation that or the situation I described at the initial meeting

Bill was not clear on that issue. And then Hawaii Medical had strong concern without having any license or permit or registration for those out of state doctors. When we process the application at least 30% doctors have malpractice or conviction issues. So when. Yes. Yeah. 30%. Yes.

And then when those things happen we don't have so consulting works because local doctors fully responsible so they can order based on the consultation. But with this Bill we don't have that kind of restriction. So if anything happens we only look at the positive things. But if this Bill pass it cost one life.

Who's going to be responsible out of state physician disappear. It's so hard for the our people to chase after those doctor.

And then if this Bill pass as it is our in state supervising physician gonna take a full response Possibly because the definition of the supervision is very broad in this field and we don't know are they going to be physically in that virtual world got to be present or what is the scope of a supervision.

There is no definition in this field so it opens too much risk for our Hawaii people here. Thank you.

Members, any other questions? Moving on to HB2319HD1 relating to the state Health Planning and Development Agency, amends the functions and responsibilities of the state Health Planning and Development Agency Hawaii Association of Health Plans in opposition.

Thank you. Chair, Vice Chair, Member of the Committee of Association of Health Ventral Standards.

HMSA offering comments.

Chair, Vice Chair, Members of the Committee, Walden Au of HMSA. We stand on our written testimony providing comments of appreciating the intent of the measure and offering one. Thank you.

Thank you. Grassroot Institute of Hawaii in support not present anyone else who'd like to testify on this measure. HB 2319.

This Bill does not expand this, you know, the regulatory authority of SHPDA in any which way. SHPDA, as you know, is a 50 year old agency.

We're just redefining the purposes kind of to focus in on our role in assuring that every citizen in Hawaii has access to high quality, equitable, affordable health care and to consider with all our sister agencies what the future of healthcare should be without any regulatory authority.

Simply the ability to try to collaborate from the siloed state of how we often exist without meaning to a sense of moving toward a real vision for what we as a state believe in. If we could have that in our state agencies. We have a lot of agencies involved with healthcare.

SHPDA has no direct healthcare services, but we do have a relationship to all those agencies and a very collegial one. If we could pull that together in terms of a shared vision, we could help the private sector try to achieve that with us. And that's kind of what we're looking at here.

There's actually a reduction of regulatory authority in this Bill because we are exempting the Department of Health from certificate of need.

We see this as a very benign and harmless piece of legislation that only clarifies our role and underscores in fact, that if you recall in your wisdom as a Legislature, you assigned the all payer claims database function in which every health plan in the state reports to SHPDA all of their medical claims which we collect in partnership with our colleagues at MedQuest and UH in the all payers claims database.

And certainly you'd want us to be able to comment on the observations we find in that database in terms of gaps in health care and means of trying to improve population health. So we just see this as a positive step that clarifies that role. Thank you very much.

Thank you. Anyone else who'd like to testify on this measure?

Jack, I have a quick question for you. It's good to get some exercise. It's just a model. A clarification on page three, line 17. The Bill refers to a state health services workforce and facilities plan. Is this the same thing as the State Health Services and Facilities plan created under HRS 3332d15

Yes, it is.

So the inserting of the word workforce, did you mean to try to rename the plan or is it?

I think we should include workforce as part of that report which which really wasn't part of it the past. But I don't see that as a powerful addition. If you'd like to edit that back to the original name.

I think I'll just call it the call it its own name. Unless you're trying to modify amendment to modify everything else to do workforce.

We'd be fine with that. Chair.

Okay. Thank you.

Any other questions? See none. Moving on to HB 1643 HD1 relating to of pharmacy specifies a framework for the Administration of audits of records of pharmacists and pharmacies. Department of Health offering comments.

Good afternoon Chair Vice Chair Members of Committee Back Department of Health Environment Health Services Division Keep it very brief. We're just providing comment and standing on our written testimony asking that it may not apply to us when we're not doing audits under 461. That's not us.

But in case we ever have to do inspections, investigations about potentially hazardous or contaminated medication that we wouldn't have to give two weeks notice and we could actually just go and do it quickly. Thank you. Available for questions.

Thank you. DCCA Board of Pharmacy offering comments.

Good afternoon. Chair, Vice Chair, Members of the Committee. My name is Christopher Fernandez, Executive Officer of the Board of Pharmacy, I'm here to stand on the board's testimony supporting the intent and offering comments. Thank you.

Thank you. HMSA with comments.

Good afternoon, Chair, Vice Chair, Members of the Committee Walden Au on behalf of HMSA we stand on our written testimony providing comments. I'm just giving the many of the PBM reforms 2026 are still yet to be implemented. We're just wondering how all of the suggested amendments from House Bill 1643 would align with that.

There are actual cases or situations that may cause misalignment that create operational and compliance challenges for health plans. That's our main concern right now. Just that there is active federal legislation and things moving at this time. Thank you.

Thank you. Moloka'i Drugs in support on Zoom.

Good afternoon Chair, Vice Chair and Members of the Committee. My name is Kimberly Mikami Svetin and I'm the President of Molokai Drugs in Kaunakakai, Hawaii. Thank you first of all for hearing this Bill. We stand on our written testimony.

There's just two more things I'd like to add number one, I did have a typo in my eighth paragraph and I wanted to say these extensive and exhausting audits are almost always for the expensive drugs like Ozempic and Zeppelin. And then the second item is related to the testimony submitted from Corey Sanders from the Hawaii Pharmacists Association.

We are also in strong support of her amendments. Finally, if you do need to talk to someone about the extensive work that is placed into these audits, I did state in my testimony that we do at least 50 of them a year. It comes out to about one a week.

And our pharmacist in charge is on the pharmacy line right now, but she will answer any questions, if you have any, regarding operations. Thank you.

Thank you, Pharmacists Association in support.

Good afternoon Chair, Vice Chair, Members of the Committee. I'll stand on my written testimony and support. I think I already got ahead of some of the questions that were brought up by HMSA at the previous testimony. We know that there are federal, federal laws that are coming down for Medicare.

Actually, I think this is a huge green light for us saying that if there are federal regulations about the auditing process and we should standardize them across all payers here locally in the state and then we are also amenable to the concerns that were brought up by the Department of Health knowing that they're not going to be auditing specific prescriptions.

But if there's anything regarding fraud, waste and abuse, then we're happy to exempt them from that process. If there are specific recommendations that HMSA has for the overpayments and the callbacks, I'm certainly happy to address those outside of testimony as this Bill continues to hopefully move forward. Thank you.

Thank you. Leanne Malapit, Individual in support on Zoom. Anyone else in person or on Zoom who'd like to testify on HB 1643 HD1. Seeing none. Members, any questions?

Moving on to the final measure, HB2121HD1 relating to waste management beginning January 12027 prohibits the sale, offer for sale or distribution for sale of any disposable electronic smoking devices in the state. First up is Department of Health in support.

Good afternoon Chair Matayoshi and Vice Chair Grandinetti and Members of the Committee. I'm representing Department of Health from the Chronic Disease Disease Prevention and Health Promotion Division.

So as you know, as we promote the health and wellness of our children, we're so glad that the youth have spoken up and the legislators have heard and HB 2121 House Draft 1 actually moves the Enforcement of Disposable E cigarettes from Chapter 342 to 328J.

And that's an area where our division ENFOR, unfortunately it doesn't have enforcement language and so we offer amendment language for that for enforcement and penalties. And so we thank you for the consideration. The reason why these are called disposable products is that they're not refillable.

Unfortunately, with the high nicotine count that's available, the lithium batteries can be rechargeable. So this definition does work because it says or, and, and yes, the product that I've talked about that I found, you know, in the parking lot, 50,000 puffs. And so you can recharge it until you finish all of the E liquid.

And that's equivalent to about five packs of cigarettes and then it's disposable. And so, and we have seen reports that youth are using them about one a week. And so in terms of the highly toxic nature of these products, in terms of the high nicotine as well as the lithium batteries, we thank you for consideration of HB2121. Thank you.

Thank you Hawaii Public Health Institute in support.

Aloha chair, Vice chair and Members of the Committee. My name is Kevin Ramirez. I'm the program manager for the Coalition for Tobacco Free Hawaii, which is a program of the Hawaii Public Health Institute. First off, I want to thank you for hearing this measure and for the opportunity to testify.

I'm here to testify in strong support of this Bill relating to waste management. For the last nine years I've been providing vaping prevention education to public and private school students, their parents and their teachers across the state. Prior to 2020, disposable E cigarettes were rather rare.

But since 2020, in the years following that, year after year they've been growing in popularity and today they dominate the market.

While there are hundreds of different types and brands of disposable E cigarettes, they all share the basic same construction and each of them are made or composed of about, I'd say no less than 10 to 15 individuals parts. The first part is either a hard metal or non biodegradable plastic shell with attached with a separate plastic mouthpiece.

And when you crack open that outer shell, you've got additional components made of plastic, whether those are switches, buttons and sometimes there's rubber moldings inside of there. There's metal components in the form of circuit board, metal wiring and also a metal coil that heats up.

There is high grade cotton that's soaked with liquid nicotine and other flavored chemicals. Many of these products come with full screen full color LCD screens. And last but not least, there's a lithium ion battery in each and every single disposable e cigarette.

After a user is done using their disposable E cigarette, they're considered hazardous waste and they end up in one of two places places. First place they often end up is in the trash can. And as disposable e cigarettes are growing in popularity, the number of fire incidents, explosions in our waste management facilities is growing nationally.

Just last year, last March, a fire, a trash truck had to dump its entire load that caught fire. The fire was linked to a lithium ion battery and had to dump its whole load on a residential street including. The second place that these things end up in is our environment.

As you can imagine, they create environmental pollution with all the different components metal can get into our environment. From the metal components, poisonous chemicals like the liquid nicotine and also the lithium ion battery is still a fire risk environment.

And also all the plastic particles and parts of contribute to the growing microplastic pollution problem in our in our world. So to best protect the health of our community and the health of our environment, kindly ask you to pass this measure.

Thank you, Amelia. Individual in support on zoom not present. Anyone else in pursuant or on Zoom would like to testify on this measure and noting. Okay, go ahead.

Aloha chair, Vice chair and Members of the Committee. Is my camera working? Oh, my name is Jeremiah and I'm speaking on behalf of the coalition for Aidaka for Hawaii Youth Council in strong support of House Bill 2121. I'm speaking on behalf of another youth council Member who is still in school right now.

We just finished an hour ago. Hawaii is facing a serious youth vaping epidemic and disposable E cigarettes are especially popular because they are cheap, easy to use and highly addictive. Many of these products are illegal, yet they remain widely available in our communities to youth like me. These devices also create a major environmental problem.

Like stated before, they contain plastic toxic chemicals and lithium ion batteries. And there's no proper way to recycle them. As a result, they end up in our landfills, oceans and beaches. And in 2023 alone, nearly 500,000 disposable vapes were thrown away every day in the United States during our beach cleanups.

Our youth council has seen how tobacco waste harms our environment, with many vapes vaping parts sinking into the sand and our ocean where they release toxic substances that thirst in our Aina and marine life. Disposable e Cigarettes also pose serious safety risks. Their batteries can overheat and catch fire when thrown away.

And we have met with representatives from H Power, Honolulu's energy facility that processes most of the waste, shared that in 2024, the facility experienced 158 fires, with 44 of them, 44 of them being lithium related.

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

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

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

So passing his House Bill 2121 is an important step towards protecting Hawaii's youth and communities. We respectfully urge you to support this Bill. Mahalo for the opportunity to testify.

Thank you so much. Anyone else in person or on Zoom who would like to testify on this measure? Seeing none. Just noting that we had two individuals submitting written testimony in opposition and 40 in support. Members, any questions? Rep Iwamoto

I have a question for the Department of Health as you're walking up. So this would also include devices, I guess, used for medical Marijuana as well,

Because it's moved to 328J. That chapter is pertaining only to tobacco products. And the definition of electronic smoking devices only pertains to tobacco products

And tobacco, then is nicotine. Yes. And if the device, and if there's no nicotine in it, is it still considered falling under this?

Thank you, Representative Iwamoto. That's a very good question and I appreciate it. The definition in 328J for tobacco products and electronic smoking devices is broad enough so that it may be products that do not contain nicotine. For medical cannabis products, there's a completely different definition of those products. Thank you. Thank you.

Department of Health.

Yes, sir. Yes Chair.

In your suggested amendment, you stated that the penalty. You suggested a penalty provision for per day and not per device. Was that intentional to have a penalty provision per day for a seller or did you mean for it to be per device offered to be sold?

It's meant for the seller because it's the. The Bill is written pertaining to the sale of the products.

So if someone's selling one or someone selling a thousand, it would be the same penalty?

Yes.

Thank you. Are you okay with it for a device instead? Or I mean, did you want to.

Chair Matayoshi. If you'd like to have it more restrictive and more punitive, we will stand with you. Thank you.

Any other questions?

Okay, recess.

Thank you everyone. Reconvening. All right, time for some decision-making. First up on the agenda, HB2323 HD1 relating to the Workers Compensation Law after some discussion with DLIR and per their testimony, Chair's recommendation is to roll this back to the original Bill Language and defect that original Bill Language is date. Members, any comments? Vice Chair for the vote.

[Roll Call]

Thank you, Members. Moving on to HB2324HD1 relating to the Hawaii Occupational Safety and Health Law we do need to make some tech amendments to this. So the Chair's recommendation is just to make some technical amendments needed for clarity, consistency, and style. Members, any comments? Vice Chair for the vote.

[Roll Call]

Moving on to HB 1509 HD1 relating to workers' compensation. Chair's recommendation is to adopt the DLIR's proposed amendment and to also change the time period from 7 days to 10 days. Members, any comments? Okay, Vice Chair for the vote.

[Roll Call]

All right, for the next two items on the agenda HB 2164 HD1 relating to workers compensation and HB 2165 HD1 relating to the Hawaii Employment Security Law we will be pushing decision making to tomorrow's agenda.

2pm CPC's agenda that's 3-4-2026 in conference room 329 we are waiting for some additional information both regarding compound drugs and for the UI office to get us what percentage of the UI clawback would be reasonable and a reasonable effective date for the setting up of their new system so we'll be addressing those in tomorrow's agenda.

Moving on to HB 2367 HD1 relating to employment Earnings Chair's recommendation is to pass this as is. Members, any comments? Vice Chair for the vote.

[Roll Call]

Moving on to HB2619HD1 relating to homemade food products. This Bill is so great we wanted to stick around past session law, so we're going to be codifying it instead of putting it into session law. Other than that, no other changes. Members, any comments? Vice Chair for the vote.

[Roll Call]

Moving on to HB 1765 HD1 relating to spearfishing safety. Chair's recommendation is to pass this as is. But in the Committee report, I do want to add to note Chair's concern about the increased possible increased cost of labeling, especially for small businesses, and the need for more functional training.

More public service announcement campaigns, something to get the word out in a way other than a label on a spear that people may or may not read would be great. Members, any comments? Vice Chair for the vote.

[Roll Call]

Moving on to HB2187HD1 relating to health care. Chairs of recommendations to pass this as is. Members, any comments? Vice Chair for the vote.

[Roll Call]

Moving on to HB 1864 HD1 relating to insurance. Chair's recommendation is to delete the word on or for HMO. For HMOs in order to remove a date discrepancy.

We'll also be reversing the third change in the Committee report from the previous Committee to allow the use of the 2018 updated update to the American Society of Clinical Oncology guidelines. We just don't want to trigger another requirement. Members, any comments?

Yes, Chair. I brought up the concern about that storage. It doesn't look like it includes storage,

Actually. Specifically. Specifically designing storage.

Yeah. And that's a concern. I think we heard SHPDA say that that would be kind of a little discriminatory to a certain degree. So with that I vote with reservations.

Yeah. You know, just having gone through it with my wife and I through IVF, I think it was like 500 bucks a month. Sorry, not a month a year that we paid. So it wasn't crippling. I googled it due to your question. I think the range is something from like 350 to 1000. So it is not insignificant.

Certainly but also not like the tens of thousands that the actual operation costs. But. Yeah.

Thank you.

Okay. Any other comments? Vice Chair for the vote.

[Roll Call]

Okay, thank you. Next up, HB 1452 HD1. Is that right? Okay. HB 1450. I'm sorry. HB 1452 HD1 relating to birth certificates. Chair's recommendation is to pass this as is. Members, any comments? Vice Chair for the vote.

[Roll Call]

Moving on to HB2314HD1 relating to emergency medical systems of care. We'll be adopting DOHs proposed amendments to bring it in line with the current HB 1752. Excuse me, I will.

I do want to note in the Committee report that these changes will need to be tracked with HB 1752 so that if HB 1752 doesn't pass, we got to change it back. It's just kind of adjusting the numbers of a certain Committee, the makeup of a certain Committee.

We also need to make a couple more conforming amendments.

The first one is to section HRS 46-191 in order to mirror the amendments to the term basic life support that are in this measure, including in the definition of paramedic in this Bill, that the paramedic be licensed under Section 453-34HRS in order to conform to some of the other definitions in that Bill and with respect to the language that DOH determines the level of emergency medical services.

To delete the word state on page 17, line 12, but to clarify that the County's authority under Section 46-196 HRS for determining its own level of emergency services holds, unless otherwise determined by the Hawaii Emergency Medical Systems of Care Advisory Council. Also met with DMH about this, which is why it's so long. Any comments, Members? Yeah, Vice Chair for the vote.

[Roll Call]

Moving on to HB 1898 HD1 relating to health. Teresa's recommendation is to adopt the AG's amendment changing the word Department to Department of Health. Will be adopting DOHs proposed amendments, which I believe already deal with the clear and convincing evidence standard.

But if not, we're going to be changing the clear and convincing evidence standard to at the Director's discretion. Members. Any comments? Vice Chair for the vote.

[Roll Call]

All right. HB 2558 HD1 relating to telehealth. I think this is an important Bill. I mean I do want this to move forward. My understanding of the Bill was a little different than how this Bill is currently structured and a little different than how the HD the proposed HD2 from the bill's introducer was.

Terms of recommendation for this Bill is for this exemption to apply, the telehealth doctor must be referred by the patient's local doctor. We'll be modifying the local supervision requirement to not apply to doctors that are part of the Interstate Medical Compact and to narrow the supervision requirements to the local doctor signing off.

Offer any prescriptions or diagnostic tests or other medical treatment requested by the telehealth doctor that are filled or performed in Hawaii.

We also are probably going to change that supervision word since it seems to be getting on a lot of people's nerves amending the Bill to make it apply only to the initial appointment between a patient and the doctor on the mainland in order to establish the doctor patient relationship, which will also include any diagnostic tests the telehealth doctor needs prior to the initial appointment.

For the initial appointment, again, subject to the previous restrictions I just mentioned, we'll be adding liability language for physicians performing telehealth medicine services implemented by the Hawaii Medical Board, subjecting them to disciplinary actions for prohibited acts and requiring out of state physicians getting an exemption to report past disciplinary actions against them to the Hawaii Medical Board at least three days prior to their initial consultation via telehealth Members. Any comments?

Chair, can you just elaborate on when you said you're going to change the supervision language?

It seems like, it seems like it's almost moved that the telehealth doctor can't practice medicine here. So they can't order anything done here. They have to just recommend it to the doctor here and the doctor here will note that anyway. So instead of.

I think people are touchy about the language supervising, as if the doctor here would be supervising someone who is the true specialist in it. So instead of supervision, I think I'd like to use the language as approved by the current doctor or something of that nature just to prevent any kind of hierarchy.

I understand. I read this Bill as being very broad and not just pertaining to specialness, but also to Mental health practitioners. There's a. There's a. Yeah, it just feels like a very broad Bill. So I'll probably be voting with reservation. I'll be voting.

Are you nervous about the breadth of it or you want the breath of it?

Well, no, I. Well, I wouldn't be as concerned if there was some kind of monitoring, compliance. I mean, I got. I did appreciate the HMV's concerns that they had. And I know they gave us a lot of recommendations and they're so small,

All of those are. We're restricting it just to the initial meeting now, so all of that other stuff is kind of gone. Any other comments? Vice Chair for the vote.

[Roll Call]