REPORT TITLE:
Osteoporosis Prevention


DESCRIPTION:
Establishes an osteoporosis prevention and treatment education
program within the department of health.  Establishes interagency
council on osteoporosis.  Appropriates funds to the DOH.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           824
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT
RELATING TO OSTEOPOROSIS.



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

 1      SECTION 1.  Chapter 321, Hawaii Revised Statutes, is amended
 
 2 by adding a new part to be appropriately designated and to read
 
 3 as follows:
 
 4     "PART .  OSTEOPOROSIS PREVENTION AND TREATMENT EDUCATION
 
 5      �321-A  Definitions.  As used in this part, unless the
 
 6 context clearly requires otherwise:
 
 7      "Council" means the interagency council on osteoporosis
 
 8 established by this part.
 
 9      "Department" means the department of health.
 
10      "Program" means the osteoporosis prevention and treatment
 
11 education program established by this part.
 
12      �321-B  Findings and purposes.(a)  The legislature finds
 
13 the following:
 
14      (1)  Osteoporosis, a bone-thinning disease, is a major
 
15           public health problem that poses a threat to the health
 
16           and quality of life to as many as twenty-eight million
 
17           Americans;
 
18      (2)  The one and one-half million fractures each year that
 
19           result from osteoporosis cause pain, disability,
 

 
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 1           immobility, and social isolation, affecting quality of
 
 2           life and threatening people's ability to live
 
 3           independently;
 
 4      (3)  Because osteoporosis progresses silently and without
 
 5           sensation over many years, and many cases remain
 
 6           undiagnosed, its first symptom is often a fracture,
 
 7           typically of the hip, spine, or wrist;
 
 8      (4)  One of two women and one of eight men will suffer an
 
 9           osteoporotic fracture in their lifetime;
 
10      (5)  A woman's risk of hip fracture is equal to her combined
 
11           risk of breast, uterine, and ovarian cancer;
 
12      (6)  The annual medical costs of osteoporosis to the health
 
13           care system are estimated to be nearly $13,800,000,000,
 
14           and are expected to rise to $60,000,000,000 to
 
15           $80,000,000,000 by the year 2020;
 
16      (7)  Since osteoporosis progresses silently and currently
 
17           has no cure, prevention, early diagnosis, and treatment
 
18           are key to reducing the prevalence of and devastation
 
19           from this disease;
 
20      (8)  Although there exists a large quantity of public
 
21           information about osteoporosis, it remains inadequately
 
22           disseminated and not tailored to meet the needs of
 

 
 
 
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 1           specific population groups;
 
 2      (9)  Most people, including physicians, health care
 
 3           providers, and government agencies, continue to lack
 
 4           knowledge in the prevention, detection, and treatment
 
 5           of the disease;
 
 6     (10)  Experts in the field of osteoporosis believe that with
 
 7           greater awareness among medical experts, service
 
 8           providers, and the public, osteoporosis can be
 
 9           prevented in the future, thereby reducing the costs of
 
10           long-term care;
 
11     (11)  Osteoporosis is a multi-generational issue because
 
12           building strong bones during youth and preserving them
 
13           during adulthood may prevent fractures in later life;
 
14           and
 
15     (12)  Educating the public and health care community
 
16           throughout the State about this potentially devastating
 
17           disease is of paramount importance and is in every
 
18           respect in the public interest and to the benefit of
 
19           all residents of the State of Hawaii.
 
20      (b)  The purposes of this part are to:
 
21      (1)  Create and foster a multi-generational, statewide
 
22           program to promote public awareness and knowledge about
 

 
 
 
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 1           the causes of osteoporosis, personal risk factors, the
 
 2           value of prevention and early detection, and the
 
 3           options available for treatment;
 
 4      (2)  Facilitate and enhance knowledge and understanding of
 
 5           osteoporosis by disseminating educational materials,
 
 6           information about research results, services, and
 
 7           strategies for prevention and treatment to patients,
 
 8           health professionals, and the public;
 
 9      (3)  Utilize educational and training resources and services
 
10           that have been developed by organizations with
 
11           appropriate expertise and knowledge of osteoporosis and
 
12           to use available technical assistance;
 
13      (4)  Evaluate existing osteoporosis services in the
 
14           community and assess the need for improving the quality
 
15           and accessibility of community-based services;
 
16      (5)  Provide easy access to clear, complete, and accurate
 
17           osteoporosis information and referral services;
 
18      (6)  Educate and train service providers, health
 
19           professionals, and physicians;
 
20      (7)  Heighten awareness about the prevention, detection, and
 
21           treatment of osteoporosis among state and county health
 
22           and human service officials, health educators, and
 

 
 
 
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 1           policy makers;
 
 2      (8)  Coordinate state programs and services to address the
 
 3           issue of osteoporosis;
 
 4      (9)  Promote the development of support groups for
 
 5           osteoporosis patients and their families and
 
 6           caregivers;
 
 7     (10)  Adequately fund these programs; and
 
 8     (11)  Provide lasting improvements in the delivery of
 
 9           osteoporosis health care, thus providing patients with
 
10           an improved quality of life and society with the
 
11           containment of health care costs.
 
12      �321-C  Osteoporosis prevention and treatment education
 
13 program.  The department of health, in cooperation with the
 
14 department of education and the executive office on aging, shall
 
15 establish, promote, and maintain an osteoporosis prevention and
 
16 treatment education program in order to raise public awareness,
 
17 educate consumers, educate and train health professionals,
 
18 teachers, and human service providers, and for other purposes.
 
19      �321-D  Program implementation.  The department shall:
 
20      (1)  Provide sufficient staff to implement the program;
 
21      (2)  Provide appropriate training for staff of the program;
 
22      (3)  Identify the appropriate entities to carry out the
 

 
 
 
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 1           program;
 
 2      (4)  Base the program on the most up-to-date scientific
 
 3           information and findings;
 
 4      (5)  Work to improve the capacity of community-based
 
 5           services available to osteoporosis patients;
 
 6      (6)  Work with the department of education, the executive
 
 7           office on aging, and other governmental offices,
 
 8           community and business leaders, community
 
 9           organizations, health care and human service providers,
 
10           and national osteoporosis organizations to coordinate
 
11           efforts and maximize state resources in the areas of
 
12           prevention, education, and treatment of osteoporosis;
 
13           and
 
14      (7)  Identify and, when appropriate, replicate or use
 
15           successful osteoporosis programs and procure related
 
16           materials and services from organizations with
 
17           appropriate expertise and knowledge of osteoporosis.
 
18      �321-E  Public awareness.  The department shall use, but is
 
19 not limited to, the following strategies for raising public
 
20 awareness on the causes and nature of osteoporosis, personal risk
 
21 factors, value of prevention and early detection, and options for
 
22 diagnosing and treating the disease:
 

 
 
 
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 1      (1)  An outreach campaign utilizing print, radio, and
 
 2           television public service announcements,
 
 3           advertisements, posters, and other materials;
 
 4      (2)  Community forums;
 
 5      (3)  Health information and risk factor assessment and
 
 6           public events;
 
 7      (4)  Targeting at-risk populations;
 
 8      (5)  Providing reliable information to policy makers; and
 
 9      (6)  Distributing information through county health
 
10           departments, schools, the executive office on aging,
 
11           area agencies on aging, employer wellness programs,
 
12           physicians, hospitals and health maintenance
 
13           organizations, women's groups, nonprofit organizations,
 
14           community-based organizations, and departmental
 
15           regional offices.
 
16      �321-F  Consumer education.  The department shall use, but
 
17 is not limited to, the following strategies for educating
 
18 consumers about risk factors, diet and exercise, diagnostic
 
19 procedures and their indications for use, risks and benefits of
 
20 drug therapies currently approved by the United States Food and
 
21 Drug Administration, environmental safety and injury prevention,
 
22 and the availability of diagnostic, treatment, and rehabilitation
 

 
 
 
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 1 services:
 
 2      (1)  Identify and obtain educational materials, including
 
 3           brochures and videotapes, which translate accurately
 
 4           the latest scientific information on osteoporosis in
 
 5           easy-to-understand terms;
 
 6      (2)  Build a statewide capacity to provide information and
 
 7           referral on all aspects of osteoporosis, including
 
 8           educational materials and counseling;
 
 9      (3)  Establish state linkage with an existing toll-free
 
10           hotline for consumers;
 
11      (4)  Facilitate the development and maintenance of
 
12           osteoporosis support groups; and
 
13      (5)  Conduct workshops and seminars for lay audiences.
 
14      �321-G  Professional education.  The department shall use,
 
15 but is not limited to, the following strategies for educating
 
16 physicians and health professionals and training community
 
17 service providers on the most up-to-date, accurate scientific and
 
18 medical information on osteoporosis prevention, diagnosis, and
 
19 treatment, therapeutic decision-making, including guidelines for
 
20 detecting and treating the disease in special populations, risks
 
21 and benefits of medications, and research advances:
 
22      (1)  Identify and obtain education materials for the
 

 
 
 
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 1           professional which translates the latest scientific and
 
 2           medical information into clinical applications;
 
 3      (2)  Raise awareness among physicians and health and human
 
 4           services professionals as to the importance of
 
 5           osteoporosis prevention, early detection, treatment,
 
 6           and rehabilitation;
 
 7      (3)  Identify and use available curricula for training
 
 8           health and human service providers and community
 
 9           leaders on osteoporosis prevention, detection, and
 
10           treatment;
 
11      (4)  Provide workshops and seminars for in-depth
 
12           professional development in the field of the care and
 
13           management of the patient with osteoporosis; and
 
14      (5)  Conduct a statewide conference on osteoporosis at
 
15           appropriate intervals.
 
16      �321-H  Needs assessment.(a)  The department shall conduct
 
17 a needs assessment to identify:
 
18      (1)  Research being conducted within the State;
 
19      (2)  Available technical assistance and educational
 
20           materials and programs nationwide;
 
21      (3)  The level of public and professional awareness about
 
22           osteoporosis;
 

 
 
 
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 1      (4)  The needs of osteoporosis patients, their families, and
 
 2           caregivers;
 
 3      (5)  Needs of health care providers, including physicians,
 
 4           nurses, managed care organizations, and other health
 
 5           care providers;
 
 6      (6)  The services available to the osteoporosis patient;
 
 7      (7)  Existence of osteoporosis treatment programs;
 
 8      (8)  Existence of osteoporosis support groups;
 
 9      (9)  Existence of rehabilitation services; and
 
10     (10)  Number and location of bone density testing equipment.
 
11      (b)  Based on the needs assessment, the department shall
 
12 develop and maintain a list of osteoporosis-related services and
 
13 osteoporosis health care providers with specialization in
 
14 services to prevent, diagnose, and treat osteoporosis.  This list
 
15 shall be made available to interested parties disseminated
 
16 pursuant to rules adopted by the department pursuant to
 
17 chapter 91 with a description of diagnostic testing procedures,
 
18 appropriate indications for their use, drug therapies currently
 
19 approved by the United States Food and Drug Administration, and a
 
20 cautionary statement about the current status of osteoporosis
 
21 research, prevention, and treatment.  The statement shall also
 
22 indicate that the department does not license, certify, or in any
 

 
 
 
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 1 way approve osteoporosis programs or centers in the State.
 
 2      �321-I  Interagency council on osteoporosis.(a)  The
 
 3 department shall establish an interagency council on
 
 4 osteoporosis.  The director of health shall chair the council.
 
 5 The council shall be composed of representatives from the
 
 6 department of education, the executive office on aging, and other
 
 7 appropriate public and private entities with expertise in such
 
 8 areas as aging, health care reform implementation, education,
 
 9 public welfare, and women's programs.
 
10      (b)  The council shall:
 
11      (1)  Coordinate osteoporosis programs conducted by or
 
12           through the department;
 
13      (2)  Establish a mechanism for sharing information on
 
14           osteoporosis among all officials and employees involved
 
15           in carrying out osteoporosis-related programs;
 
16      (3)  Review and coordinate the most promising areas of
 
17           education, prevention, and treatment concerning
 
18           osteoporosis;
 
19      (4)  Assist the department and other offices in developing
 
20           and coordinating plans for education and health
 
21           promotion on osteoporosis;
 
22      (5)  Establish mechanisms to use the results of research
 

 
 
 
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 1           concerning osteoporosis in the development of relevant
 
 2           policies and programs; and
 
 3      (6)  Prepare a report that describes educational initiatives
 
 4           on osteoporosis sponsored by the State and makes
 
 5           recommendations for new educational initiatives on
 
 6           osteoporosis, and transmit the report to the
 
 7           legislature and make the report available to the
 
 8           public.
 
 9      (c)  The interagency council on osteoporosis shall establish
 
10 and coordinate an advisory panel on osteoporosis, which shall
 
11 provide nongovernmental input regarding the osteoporosis
 
12 prevention and treatment education program.  Membership shall
 
13 include, but is not limited to, persons with osteoporosis,
 
14 women's health organizations, public health educators,
 
15 osteoporosis experts, providers of osteoporosis health care,
 
16 persons knowledgeable in health promotion and education, and
 
17 representatives of national osteoporosis organizations or their
 
18 state or regional affiliates.
 
19      �321-J  Technical assistance.(a)  Notwithstanding any law
 
20 to the contrary, the department may replicate and use successful
 
21 osteoporosis programs and enter into contracts and purchase
 
22 materials or services from private organizations with appropriate
 

 
 
 
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 1 expertise and knowledge of osteoporosis for such services and
 
 2 materials as, but not limited to, the following:
 
 3      (1)  Educational information and materials on the causes,
 
 4           prevention, detection, treatment, and management of
 
 5           osteoporosis;
 
 6      (2)  Training of staff;
 
 7      (3)  Physicians and health care professional education and
 
 8           training, and clinical conferences;
 
 9      (4)  Conference organization and staffing;
 
10      (5)  Regional office development and staffing;
 
11      (6)  Nominations for advisory panels;
 
12      (7)  Support group development;
 
13      (8)  Consultation;
 
14      (9)  Resource library facilities;
 
15     (10)  Training home health aides and nursing home personnel;
 
16           and
 
17     (11)  Training teachers.
 
18      (b)  The department may enter into agreements to work with
 
19 national organizations with expertise in osteoporosis to
 
20 establish and staff offices of those organizations in the State
 
21 to implement parts of the osteoporosis program.
 
22      (c)  This section shall not supersede collective bargaining
 

 
 
 
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 1 agreements, civil service laws, or any other laws protecting
 
 2 employee rights, nor shall any employee be adversely affected by
 
 3 this section.
 
 4      �321-K  Contributions.  The department may accept grants,
 
 5 services, and property from the federal government, foundations,
 
 6 organizations, medical schools, and other entities as may be
 
 7 available for the purposes of fulfilling the obligations of this
 
 8 program.
 
 9      �321-L  Waivers.  The department shall seek any federal
 
10 waiver or waivers that may be necessary to maximize funds from
 
11 the federal government to implement this program.
 
12      �321-M  Rules.  The department of health, with the
 
13 assistance of the department of education and the executive
 
14 office on aging, shall adopt rules pursuant to chapter 91 as may
 
15 be necessary to implement this part."
 
16      SECTION 2.  There is appropriated out of the general
 
17 revenues of the State of Hawaii the sum of $          , or so
 
18 much thereof as may be necessary for fiscal year 1999-2000, for
 
19 the establishment of an osteoporosis prevention and treatment
 
20 education program within the department of health as provided in
 
21 this Act.  The sum appropriated shall be expended by the
 
22 department of health for the purposes of this Act.
 

 
 
 
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 1      SECTION 3.  In codifying the new part added by section 1 of
 
 2 this Act, the revisor of statutes shall substitute appropriate
 
 3 section numbers for the letters used in the new sections
 
 4 designated in this Act.
 
 5      SECTION 4.  This Act shall take effect upon its approval;
 
 6 provided that section 2 of this Act shall take effect on July 1,
 
 7 1999.
 
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 9                           INTRODUCED BY:  _______________________
 
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