SB3126 HD1

SECTION 1. The legislature finds that most rural communities have fewer health care resources compared to residents on Oahu, including access to advanced levels of trauma care, medical specialists, and sub-specialists. This puts patients in these underserved areas at greater risk of poor outcomes for serious medical conditions such as heart attacks, strokes, and traumatic bodily injuries.

The existing system of interisland transport of patients for health care services is overburdened. The State is currently served by only one interisland aeromedical provider, for which there are few viable and cost-effective alternatives in the event of a grounding, for example, due to maintenance issues or crew availability. Emergency aeromedical services are also not available for many patients in rural counties.

The legislature further finds that disruptions to interisland medical transports pose a risk to human health and safety, and therefore the consistent availability of interisland medical transport and the overall resiliency of emergency aeromedical services must be improved.

One model to improve emergency aeromedical services could be based on the county of Maui's medevac service. Act 213, Session Laws of Hawaii 2007, appropriated general funds for the purchase of a twin-engine helicopter capable of medical transport between Maui and Oahu to be operated by the county of Maui medical emergency aeromedical services program. The department of health cost shares the helicopter with the county of Maui. The department bills for services and private sector entities are contracted to provide the pilots, aircraft maintenance technicians, and the medical flight staff. The legislature finds that implementing the Maui model across the State will increase the availability of reliable aeromedical transport to all of the State's residents.

Accordingly, the purpose of this Act is to ensure the availability of air ambulance services through the establishment of an emergency aeromedical services partnership program administered by the department of health in partnership with rural counties.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to part XVIII to be appropriately designated and to read as follows:

"§321- State emergency aeromedical services partnership program; established. (a) The department shall establish, administer, and maintain, in cooperation with each county in the state emergency medical services system service area, an emergency aeromedical services partnership program. The department shall consult with the advisory committee pursuant to section 321-225 to implement this section.

(b) The department shall enter into a memorandum of agreement with the county of Kauai, county of Maui, and county of Hawaii to implement and maintain an emergency aeromedical services partnership program. At a minimum, each memorandum of agreement shall define responsibilities as follows:

(1) The department shall provide funds for the provision and maintenance of a rotary-wing aircraft;

(2) The counties shall provide funds for the operations of the rotary-wing aircraft, including flight crew and medical staff; and

(3) The State and counties shall identify and document applicable federal regulations and jurisdictions, and shall amend the memorandums of agreement as necessary.

(c) The county of Kauai, county of Maui, and county of Hawaii shall submit to the department all necessary information for purposes of submitting claims for third-party reimbursement within thirty days of the service for any emergency aeromedical services provided. Funds received from reimbursements shall be deposited into the emergency medical services special fund, established pursuant to section 321-234.

(d) The department shall establish statewide standards for the emergency aeromedical services partnership program consistent with this part and applicable federal regulations for those services.

(e) The director of health may adopt rules pursuant to chapter 91 to effectuate the purposes of this section.

(f) No later than January 4, 2026, the department shall adopt interim rules, which shall be exempt from chapter 91 and chapter 201M, to effectuate the purposes of this section; provided that the interim rules shall remain in effect until July 1, 2028, or until rules are adopted pursuant to subsection (e), whichever occurs sooner.

(g) The department may amend the interim rules, and the amendments shall be exempt from chapters 91 and 201M, to effectuate the purposes of this section; provided that any amended interim rules shall remain in effect until July 1, 2028, or until rules are adopted pursuant to subsection (e), whichever occurs sooner."

SECTION 3. Section 321-232, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The department shall establish reasonable fees for services rendered to the public within the service area by the department, any county within the service area, or private agency under this part; provided that all revenues collected by the department and the respective counties pursuant to this section shall be deposited into the state general fund, except [~~amounts~~]:

(1) Amounts necessary to provide for collection services for bad debt accounts[.]; and

(2) Funds received from reimbursements for emergency aeromedical services and deposited into the emergency medical services special fund pursuant to section 321-234(c).

Fees required to be set by this section shall be established in accordance with chapter 91."

SECTION 4. Section 321-234, Hawaii Revised Statutes, is amended by amending subsections (b) and (c) to read as follows:

"(b) The moneys in the special fund shall be distributed as follows:

(1) Beginning with fiscal year 2021-2022, $3,500,000 shall be distributed each fiscal year to a county operating a county emergency medical services system pursuant to part XI of chapter 46 for the operation of that system; [~~and~~]

(2) Beginning with fiscal year 2024-2025, each quarter, the deposits from reimbursements for emergency aeromedical services for the previous quarter shall be disbursed to the counties in the service area as follows:

(A) Fifty per cent shall be divided equally among the counties; and

(B) Fifty per cent shall be divided proportionately based on the billed amount submitted by each county; and

(3) The remainder shall be distributed to the department for operating the system established pursuant to this chapter, including enhanced and expanded services, and shall not be used to supplant funding for emergency medical services authorized prior to July 1, 2004.

(c) Fees remitted pursuant to section 249-31, cigarette tax revenues designated under section 245-15, interest and investment earnings attributable to the moneys in the special fund, legislative appropriations, and grants, donations, [~~and~~] contributions from private or public sources for the purposes of the fund, and funds received from reimbursements for emergency aeromedical services pursuant to section 321- , shall be deposited into the special fund."

SECTION 5. 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 6. 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 be deposited into the emergency medical services special fund.

SECTION 7. There is appropriated out of the emergency medical services special fund the sum of $ or so much thereof as may be necessary for fiscal year 2024-2025 for the establishment of the emergency aeromedical services partnership program.

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

SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 9. This Act shall take effect on July 1, 3000.

THE SENATE	S.B. NO.	3126
THIRTY-SECOND LEGISLATURE, 2024		S.D. 1
STATE OF HAWAII		H.D. 1