HB2759 HD1

SECTION 1. The legislature finds that the Hawaii keiki: healthy and ready to learn program (Hawaii keiki program) is designed to improve access to quality school-based health services for Hawaii's public school students by providing direct services and coordinating care with primary and tertiary care providers. Further, the Hawaii keiki program screens, identifies, and meets needs, such as for oral and mental health services, by seeking and obtaining private funds as needed. This partnership program with the university of Hawaii at Manoa Nancy Atmospera-Walch school of nursing supports the department of education in achieving student, school, and system success by providing health nursing services to public schools, thus allowing school and department staff to focus on their mission to educate the State's children.

In the last three years, the Hawaii keiki program has provided direct on-site services in over one hundred seventy-one schools, and indirect support to all department of education schools, complexes, and complex areas. Critical to the expansion of services are health technicians who are community health workers, medical assistants, and certified nurse assistants. Under the supervision of the registered nurses, health technicians support on-site health room visits; implement nursing orders; facilitate virtual nursing visits; facilitate health screening efforts; support staff, parent, and student health education; and provide health support to the campus.

The legislature finds that health technicians have significantly increased the capacity of the registered nurses and advanced practice registered nurses to complete high-level nursing tasks. Hawaii keiki program visits increased from 8,188 in school year 2019-2020 to 126,994 in school year 2022-2023, an increase of 1,451 per cent, due to services provided by health technicians. In addition, the legislature finds that student and staff education encounters increased from 3,911 to 17,339, an increase of three hundred forty-three per cent; keiki health screenings increased from 3,962 to 11,027, an increase of one hundred seventy-eight per cent; and support for individual student health care plans, such as plans pursuant to section 504 of the Rehabilitation Act of 1993 individualized education programs, increased from two hundred to five hundred twenty-five, an increase of one hundred sixty-three per cent. The legislature notes that with regard to output of Hawaii keiki services, health technicians increase productivity by up to sixty per cent compared to nursing care alone. Health technicians are critical team members of the Hawaii keiki program and enable more students to receive the screenings, care, and health plans needed to support their optimal learning environments and maintain their health while at school.

The legislature further recognizes that the unique partnership of the Hawaii keiki program between department of education public schools and the university of Hawaii at Manoa Nancy Atmospera-Walch school of nursing enhances support to school staff and increases health services to children. Notably, with the addition of health technicians, school health assistants have seen visits increase from 40,941 to 279,475, an increase of five hundred eighty-three per cent, and an increase of school health assistant utilization of electronic records by 22.4 per cent.

The legislature envisions a future with one nurse on site at every school but recognizes that achieving that goal requires a substantial increase in fiscal and human resources. Health technicians are an efficient and cost-effective approach to increasing access to the available nursing services, assisting the department of education to meet the goal of student and school academic success by ensuring students are healthy and ready to learn. The legislature finds that maintaining seventy-five health technician positions throughout the State will maintain the optimized Hawaii keiki environment within department of education schools. Of the seventy-five health technicians, fifty-eight are partnered with registered nurses or advanced practice registered nurses to allow nurses to engage in direct clinical care and maximize the team approach that creates efficiency, increased visits, case management, preventative services, and individual health care plans; and seventeen are distributed to complex areas with challenging geographic spread and high needs.

The legislature is committed to providing continued support to children enrolled in department of education schools by ensuring that they are healthy and ready to learn, and commends health technicians in playing a critical function in the Hawaii keiki program, including rapidly responding to high-demand complex area needs and processing data entry for department of education student health records.

Accordingly, the purpose of this Act is to appropriate funds to maintain seventy-five health technician positions within the department of education for the Hawaii keiki program.

SECTION 2. In accordance with section 9 of article VII of the Hawaii State Constitution and sections 37-91 and 37-93, Hawaii Revised Statutes, the legislature has determined that the appropriations contained in Act 164, Regular Session of 2023, and this Act will cause the state general fund expenditure ceiling for fiscal year 2024-2025 to be exceeded by $ or per cent. This current declaration takes into account general fund appropriations authorized for fiscal year 2024-2025 in Act 164, Regular Session of 2023, and this Act only. The reasons for exceeding the general fund expenditure ceiling are that:

(1) The appropriation made in this Act is necessary to serve the public interest; and

(2) The appropriation made in this Act meets the needs addressed by this Act.

SECTION 3. 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 2024-2025 to maintain seventy-five health technician positions within the department of education for the Hawaii keiki: healthy and ready to learn program.

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

SECTION 4. This Act shall take effect on July 1, 3000.

HOUSE OF REPRESENTATIVES	H.B. NO.	2759
THIRTY-SECOND LEGISLATURE, 2024		H.D. 1
STATE OF HAWAII