HB2508

SECTION 1. The legislature finds that air medical services are an essential component of Hawaii's emergency medical systems of care, healthcare infrastructure, and all-hazards disaster preparedness. Hawaii's geographic isolation, multi-island structure, rural communities, and limited access to specialty and tertiary care on neighbor islands make timely air medical transport critical to providing equitable access to lifesaving care.

The legislature further finds that demand for emergency aeromedical and interfacility air medical transport services has increased substantially over the past decade, with annual flight volumes exceeding pre-2020 levels by more than one thousand transports. However, statutory authority, governance structures, and department of health staffing dedicated to air medical services have not kept pace, resulting in fragmented coordination, prolonged transport times, and inefficient systems.

The legislature recognizes that the emergency medical services and injury prevention systems branch of the department of health lacks permanent, dedicated air medical staffing to support statewide coordination, regulatory oversight, quality improvement, data governance, and disaster readiness.

The legislature further finds that statewide air medical performance data demonstrate persistent delays that exceed nationally recognized benchmarks for rural and remote emergency care, reflecting structural gaps in coordination and governance rather than performance issues with isolated providers.

The legislature acknowledges that nationally recognized best practices emphasize centralized governance, clinically driven coordination, continuous quality improvement, and integration with trauma, stroke, cardiac, acute care, emergency medical systems, and disaster response. In an island state, air medical services are a core public health, public safety, and emergency preparedness function.

Accordingly, the purpose of this Act is to:

(1) Establish permanent, dedicated air medical staffing within the emergency medical services and injury prevention systems branch of the department of health;

(2) Strengthen statewide governance, coordination, and oversight of emergency aeromedical and interfacility air medical services;

(3) Support data-driven quality improvement, accountability, and performance monitoring;

(4) Enhance disaster preparedness and multi-island response through clearly defined authority and coordinated air medical operations; and

(5) Promote health equity by improving timely access to emergency medical care for rural and neighbor island communities.

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- Statewide air medical services program; staffing and authority. (a) There is established within the department's emergency medical services and injury prevention system branch, a statewide air medical services program to provide governance, coordination, oversight, quality improvement, and disaster readiness for the State's emergency aeromedical and interfacility air medical transport services.

(b) The department shall establish and maintain permanent positions to administer the program, including:

(1) A state air medical director, who shall be a physician licensed in the State and having experience in emergency medicine, trauma care, or critical care transport, who shall provide statewide clinical and medical oversight of air medical services;

(2) A state air medical program manager, who shall be responsible for program administration; policy development; system planning; interagency coordination; and integration of air medical services with emergency medical services, trauma systems, and healthcare facilities; and

(3) An air medical coordinator, who shall support operational coordination, data oversight, compliance monitoring, performance improvement activities, and coordination with licensed air medical providers, county emergency medical services agencies, hospitals, and emergency management partners.

(c) The positions established pursuant to subsection (b) shall be permanent and recurring and shall not be contingent upon temporary programs, pilot projects, or time-limited funding.

(d) The statewide air medical services program, under the direction of the director of health, may:

(1) Provide statewide clinical governance and medical direction for emergency aeromedical and interfacility air medical services;

(2) Develop, adopt, and implement statewide air medical policies, procedures, and clinical protocols consistent with nationally recognized standards;

(3) Coordinate emergency aeromedical and interfacility air medical transport services across counties to improve timeliness, health equity, and access to care;

(4) Oversee the participation of licensed air medical providers in data-based quality improvement programs;

(5) Support statewide disaster preparedness, response, and recovery activities involving air medical transport, including multi-island and mass-casualty incidents; and

(6) Coordinate with county emergency medical services agencies, hospitals, trauma centers, stroke centers, acute care facilities, emergency management agencies, and other public and private partners.

(e) The department may adopt rules pursuant to chapter 91 necessary to implement this section.

(f) As a condition of licensure, all air medical providers operating within the State shall cooperate with and participate in statewide air medical coordination, data reporting, and quality improvement activities as required by the department.

(g) The statewide air medical services program shall coordinate with the state emergency medical services advisory committee and may establish advisory or quality improvement committees as necessary to fulfill its statutory responsibilities.

(h) The department shall establish and assess annual air medical ambulance licensure and accreditation fees for all air medical providers operating within the State.

The fees shall be reasonable, non-refundable, and sufficient to fully cover the costs associated with:

(1) Administration and oversight of the statewide air medical services program;

(2) Licensure, accreditation verification, compliance monitoring, and enforcement activities;

(3) Statewide air medical coordination and quality improvement initiatives;

(4) Data collection, analysis, and reporting requirements; and

(5) Coordination and integration with state and county emergency management, emergency medical services, and disaster preparedness partners.

The fees collected pursuant to this subsection shall be deposited into the emergency medical services special fund established pursuant to section 321-234 and shall be used solely for the purposes of administering and supporting the statewide air medical services program and staff, and its emergency management coordination functions."

SECTION 3. Section 321-234, Hawaii Revised Statutes, is amended by amending subsection (b) 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) Fees remitted pursuant to section 321- shall be used solely for the purposes of administering and supporting the statewide air medical services program and staff, and its emergency management coordination functions; and

[~~(2)~~] (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."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	2508
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII