REPORT TITLE:
Rural Health


DESCRIPTION:
Establishes a statewide rural health plan; creates rural health
special fund; requests counties to create a position of rural
transportation coordinator.  (SD3)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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THE SENATE                              S.B. NO.           S.D. 3
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1                              Part I
 
 2      SECTION 1.  The legislature finds that adequate health care
 
 3 for the rural districts of the Big Island are sorely lacking.  In
 
 4 response to this urgent need, Senate Concurrent Resolution
 
 5 No. 31, 1998, requested the state department of health to develop
 
 6 a rural health plan for the island of Hawaii, including the
 
 7 districts of Puna and Ka`u, to ensure the improvement of health
 
 8 facilities and to make available sufficient medical services.
 
 9      In its report to the legislature pursuant to the concurrent
 
10 resolution, the department of health found that the rural
 
11 community perceptions are that comprehensive medical care must
 
12 come first before the economic situation in Ka`u will improve,
 
13 that elderly retirees have limited access to specialists and may
 
14 suffer long waits for transportation to larger or specialized
 
15 facilities, and that there are too few medical facilities in
 
16 places with inadequate transportation and a dispersed population
 
17 over a large geographic area.
 
18      The legislature further finds that compared to the state
 
19 population, Puna has the worst overall socio-economic status in
 

 
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 1 the State, including the second worst per capita income ($9,450),
 
 2 second highest percentage of population below two hundred per
 
 3 cent of the federal poverty level, second highest percentage of
 
 4 households receiving public financial aid, third highest
 
 5 percentage of households receiving food stamps, and fourth
 
 6 highest unemployment rate.  The legislature further finds that
 
 7 Puna has the fourth highest level of overall health risk in the
 
 8 State, including the second highest rate of births to mothers
 
 9 with pre-existing medical conditions, fourth highest percentage
 
10 of low birth weights, fifth highest rate of infant mortality, and
 
11 sixth highest percentage of teen births.
 
12      The legislature further finds that compared to the state
 
13 population, Ka`u has the third worst rate for socio-economic
 
14 status, including the fourth highest percentage of population
 
15 below two hundred per cent of the federal poverty level, fourth
 
16 highest percentage of households receiving public financial aid,
 
17 fourth highest percentage of households receiving food stamps,
 
18 fifth worst per capita income, fifth highest unemployment rate,
 
19 and fifth highest percentage of adults without a high school
 
20 diploma.  The legislature further finds that Ka`u has the second
 
21 highest level of overall health risk in the State, including the
 
22 highest percentage of teen births, highest percentage of births
 

 
 
 
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 1 with low birth weight, third highest percentage of births with
 
 2 inadequate prenatal care, and seventh highest infant mortality
 
 3 rate.
 
 4      The legislature further finds that the health profiles of
 
 5 Ka`u and Puna could be immensely improved with adequate funding
 
 6 for health care needs and with decent public transportation.
 
 7      The purpose of this Act is to implement the recommendations
 
 8 of the department of health to improve the provision of adequate
 
 9 health care services and public transportation for rural
 
10 communities.
 
11      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
 
12 by adding a new section to part I to be appropriately designated
 
13 and to read as follows:
 
14      "§321-    Statewide rural health plan; rural health special
 
15 fund.  (a)  The department of health shall develop a statewide
 
16 rural health plan in order to:
 
17      (1)  Obtain federal funds to access health care in rural
 
18           communities by creating a network of services and
 
19           resources within the State; and
 
20      (2)  Improve the efficiency and minimize the financial costs
 
21           of rural care by allowing flexibility in staffing and
 
22           in the number and type of beds maintained as a
 

 
 
 
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 1           requirement of federal funding subsidies.
 
 2      (b)  The statewide rural health plan shall be developed and
 
 3 administered by the department of health in conformity with
 
 4 federal requirements for receiving grants pertaining to rural
 
 5 health.
 
 6      (c)  There is established within the state treasury the
 
 7 rural health special fund to be administered and expended by the
 
 8 department of health, into which shall be deposited, if required
 
 9 by federal law or regulation, funds relating to rural health.
 
10 Moneys in the fund shall be expended exclusively for improvement
 
11 of rural health needs and in accordance with federal
 
12 requirements."
 
13      SECTION 3.  In recognition of article VIII, section 2 of the
 
14 state constitution, each county is requested to establish a
 
15 position for a rural transportation coordinator, to assist in the
 
16 identification, establishment, funding, and coordination of
 
17 affordable and convenient public rural transportation services,
 
18 particularly for the county of Hawaii, to allow residents to
 
19 access health care in the Ka`u district, island of Hawaii.  The
 
20 coordinator shall develop a plan, with the assistance of the
 
21 state department of health, county public transportation
 
22 agencies, and private nonprofit agencies providing transportation
 

 
 
 
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 1 services to the elderly and disabled, to establish a public rural
 
 2 transportation system for the Ka`u district, particularly to
 
 3 provide affordable and convenient access to health care services,
 
 4 including primary providers, emergency facilities, and hospitals.
 
 5 The legislature finds this request is not a mandated program
 
 6 under Article VIII, section 4, of the state constitution.
 
 7      SECTION 4.  It is the intent of this Act not to jeopardize
 
 8 the receipt of any federal aid nor to impair the obligation of
 
 9 the State or any agency thereof to the holders of any bond issued
 
10 by the State or by any such agency, and to the extent, and only
 
11 to the extent, necessary to effectuate this intent, the governor
 
12 may modify the strict provisions of this Act, but shall promptly
 
13 report any such modification with reasons therefor to the
 
14 legislature at its next session thereafter for review by the
 
15 legislature.
 
16                              Part II
 
17      SECTION 5.  The Hawaii health systems corporation, with the
 
18 approval of the governor, is authorized to issue revenue bonds in
 
19 the sum of $60,000,000, or so much thereof as may be necessary,
 
20 and the same sum, or so much thereof as may be necessary, is
 
21 appropriated for fiscal year 1999-2000, for the following
 
22 projects:
 

 
 
 
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 1      1.   Hilo Medical Center
 
 2           Plans, design, construction, equipment,
 
 3           and furnishings relating to facilities for
 
 4           Hilo Medical Center.                        $25,000,000
 
 5      2.   Kona Community Hospital
 
 6           Plans, design, construction and
 
 7           furnishings relating to facilities for Kona
 
 8           Community Hospital.                         $ 5,000,000
 
 9      3.   
 
10           Plans, design, construction, equipment, and
 
11           furnishings relating to facilities for
 
12                                                       $30,000,000
 
13      SECTION 6.  The revenue bonds authorized in this Act shall
 
14 be issued pursuant to part III of chapter 39, Hawaii Revised
 
15 Statutes, and chapter 323F, Hawaii Revised Statutes.
 
16      SECTION 7.  The appropriations made for the capital
 
17 improvement projects authorized in this Act shall not lapse at
 
18 the end of fiscal year 1999-2000 for which the appropriations are
 
19 made; provided that all appropriations made to be expended in
 
20 fiscal year 1999-2000 which are unencumbered as of June 30, 2001,
 
21 shall lapse as of that date.
 
22      SECTION 8.  The sum appropriated shall be expended by the
 

 
 
 
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 1 Hawaii health systems corporation for the purposes of this Act.
 
 2      SECTION 9.  New statutory material is underscored.
 
 3      SECTION 10.  This Act shall take effect upon its approval,
 
 4 except that sections 5, 6, 7, and 8 shall take effect on July 1,
 
 5 1999.