SB2666 SD1

SECTION 1. The legislature finds that the Waianae Coast Comprehensive Health Center (Center) was established in 1972 to provide primary care services for the federally designated and medically underserved Waianae coast with operating funds granted through the department of health and human services.

The legislature further finds that today, as was true since its establishment, the Center fulfills its mission as a community-owned and community-operated nonprofit medical facility serving an ever expanding Waianae coast community of some fifty thousand residents. The Center serves thirty-seven thousand patients annually through its main center in Waianae; satellite clinics in Waianae and Nanakuli; school-based sites in Waianae and Nanakuli; and satellite clinics in Kapolei, Ewa, and Waipahu. The majority of patients served are native Hawaiian (forty-seven per cent), followed by Asian and other Pacific Islanders (twenty-eight per cent). Sixty-five per cent of patients are at one hundred per cent of the federal poverty level or below; seven per cent are uninsured; and fifty-eight per cent are receiving coverage under QUEST, the State's medicaid program.

The vision of the founders of the Center, to offer comprehensive health services, has guided the development of the services and activities of the Center's patient-centered health care home. The Center achieves its mission by not only serving patients who seek services but also by incorporating the goal of improving the overall health status of the community it serves.

Emergency medical services, while not a core service supported by department funding, was identified by the community as a vital service for the Waianae coast. The Center began offering emergency medical services on a limited basis in 1976 through private funding. From 1986, with assistance from the legislature, the Center's emergency department has been able to be open twenty-four hours per day on a year-round basis. Subsidy funding from the legislature has supported the Center's emergency department operations between the hours of midnight to 8:00 a.m., along with providing laboratory and imaging services.

The Center's emergency department is one of the most heavily utilized on Oahu, serving twelve thousand patients totaling 21,422 visits in 2019-2020. For the midnight to 8:00 a.m. period, there were 3,149 visits with more than sixty per cent being patients covered under medicaid and ninety-three per cent being residents of the Waianae coast. The most severe pathology seen from midnight to 8:00 a.m. includes chest pain and congestive heart failure; respiratory distress; trauma; labor; and mental illness or substance abuse issues.

The Center's participation and role in the statewide Emergency Medical System is substantial. With recognition by the State as a trauma support facility, the Center serves as a safety net for the residents of the Waianae coast. The Center is connected to the State Emergency Management System, which connects all Hawaii hospitals and the emergency medical services system. The Center's emergency department is rated as a Type II facility (out of three types) for hospital capability for readiness. The Center's emergency department is used by the Honolulu police department and child protective services. The Honolulu police department brings individuals in custody to the emergency department for medical care. Child protective services uses the emergency department for pre-placement physical exams when children are removed from their parents or guardians.

As the primary medical provider on the Waianae coast, the Center fills a major role in providing health services to the community, which allows the State to focus its limited resources in other areas. The twenty-four-hour emergency services provided by the Center addresses the unique challenges of the community that are presented by being on the most western point of Oahu, such as isolation caused by road closures, natural disasters, and traffic; in addition, the Center addresses more universal health challenges, such as the need to stabilize trauma victims and the need to stabilize patients to avoid hospitalization. Increased homelessness, economic conditions, and behavioral health conditions have also increased the demand for emergency medical services on the Waianae coast, but this increase in demand has not been matched by an increase in State funding.

The Center's operating costs for the midnight to 8:00 a.m. period was $5,551,000 in 2019-2020. However, the funding level the legislature has provided to the Center since 1986 to the present has remained at $1,468,000. The difference between current legislative support provided through the department of health and the actual cost to operate services between midnight to 8:00 a.m. is expected to be $4,403,000 for the fiscal year ending June 30, 2022.

There are many factors that contribute to the inability of the Center to support itself financially, such as:

(1) The emergency department services a low-income, uninsured, and underinsured population;

(2) The emergency department serves a large homeless population on the Waianae coast;

(3) The economic base of the community is not able to support medical services on a fee-for-service basis and must absorb the cost of uninsured and underinsured patients;

(4) Due to the Center's status as a federally qualified health center, the Center is not allowed the benefit of hospital-based emergency departments to bill an emergency department facility fee for emergency patients covered under the federal medicaid, medicare, and tri-care programs. Patients under these federal programs make up seventy per cent of the Center's base;

(5) The State's uninsured funding is capped at $100 per visit for uninsured primary care visits and does not cover the full cost of the uninsured emergency department visits; and

(6) Other rural communities receive a large state subsidy for emergency services through the state hospital system; however, the Center does not receive proportionate support.

The legislature recognizes that a dependable, multi-year financial commitment by the State in supporting emergency medical services at the Center is the most effective way to ensure that residents throughout the Waianae coast receive appropriate medical care and that the community is served during a disaster. Although the federal medicaid Medical Assistance Percentage reimbursement is a potential source of funding, the legislature recognizes that failure to increase state funding to the Center to bring funding levels in line with increased demands for services may result in the Center having to reduce hours of vital services to the Waianae coast community.

The purpose of this Act is to provide the Waianae Coast Comprehensive Health Center with a grant in order to assist the Center in continuing twenty-four-hour, year-round emergency department services to residents of the Waianae coast to ensure emergency medical and disaster-related response services are available for the fifty thousand residents of the Waianae coast.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2022-2023 as a grant pursuant to chapter 42F, Hawaii Revised Statutes, to the Waianae Coast Comprehensive Health Center for operation of its twenty-four-hour emergency department.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 3. This Act shall take effect on January 1, 2050.

THE SENATE	S.B. NO.	2666
THIRTY-FIRST LEGISLATURE, 2022		S.D. 1
STATE OF HAWAII