SECTION 1. Medicare beneficiaries in Hawaii are experiencing a reduction in access to quality care as a result of the change in the way medicare purchases its durable medical equipment and prosthetics, orthotics, and supplies. Round two of medicare's durable medical equipment competitive bidding program began July 1, 2013, in the city and county of Honolulu. The unintended consequences of the implementation of this national program in Honolulu have been disastrous.

Only thirteen of the ninety-seven vendors selected are located within the State. The minimum shipping time is two to four days and the typical wait time for physician-ordered wheelchairs and hospital beds is four to eight weeks. These vendors do not have special phone or service hours to account for the time difference, which means that when medicare beneficiaries in Hawaii call after 11:00 a.m., the offices are closed. Without access to timely, local services, medicare beneficiaries in Hawaii have been forced to forego necessary durable medical equipment devices. This restricted access to care has led to reductions in health, increases in preventable admissions and readmissions, increases in costs to beneficiaries and the medicare system, and negative impacts on quality of life for medicare patients.

The national bidding program has the laudable intention of cutting down on fraud and abuse and reducing medicare costs nationally. A reduction in cost, however, by twelve to fifty-six per cent in Hawaii is unsustainable, given the fixed costs of higher rent, utilities, and shipping costs that businesses in Hawaii face. Hawaii's fees are now on par with those in the Washington, D.C. area, even though the cost of living index in Honolulu is 21.4 per cent higher than that for Washington, D.C.

Medicare costs in Hawaii are already low. A review of 2011 fee-for-service medicare spending for durable medical equipment shows that Hawaii has the lowest per capita durable medical equipment cost in the nation. On average, each Hawaii beneficiary consumes only $82.54 in durable medical equipment, compared with $230.16 nationally. Furthermore, the total medicare cost for a Hawaii beneficiary, on average, is only $530.98, compared with $792.99 nationally.

The office of health care assurance is organized under the state department of health under chapter 321, Hawaii Revised Statutes, to perform all state licensing activities for healthcare facilities, agencies, and organizations in Hawaii, including conducting all on-site state licensing surveys and medicare certification surveys on behalf of the United States Centers for Medicare and Medicaid Services.

The purpose of this Act is to provide for the licensure of durable medical equipment suppliers participating in the nationwide competitive bidding program under the oversight of the office of health care assurance.

SECTION 2. Due to exigent circumstances, the legislature finds that this licensure program is needed immediately to ensure that Hawaii's patients have timely access to the critical, life-sustaining medical supplies they need and therefore declares that this licensure program shall be exempt from the requirements of section 26H-6, Hawaii Revised Statutes.

SECTION 3. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"PART .

SUPPLIER OF DURABLE MEDICAL EQUIPMENT LICENSING PROGRAM

§321-A Title. This part shall be known and may be cited as the " Supplier of Durable Medical Equipment Licensing Program."

§321-B Findings and declaration of necessity. It is the intent of the legislature to establish standards for the licensing of durable medical equipment suppliers participating in the nationwide competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies established by section 302 of the federal Medicare Modernization Act of 2003 to protect medical patients in the State from life threatening delays in receiving life-sustaining durable medical equipment that must be shipped from the mainland.

§321-C Definitions. As used in this part:

"Appropriate physical location" means a physical facility within the boundaries of the State used to store durable medical equipment inventory.

"Durable medical equipment" means equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, is generally not useful to a person in the absence of an illness or injury, is appropriate for use in the home, and is deemed to include prosthetics, orthotics, and related supplies.

"Supplier" means a supplier of durable medical equipment.

§321-D Licensing. (a) Any supplier who intends to participate in the nationwide competitive bidding program for durable medical equipment established by section 302 of the federal Medicare Modernization Act of 2003 shall be licensed pursuant to this part.

(b) A supplier shall be deemed licensed if:

(1) The supplier maintains an appropriate physical location within the State;

(2) The supplier has passed an annual inspection performed by the office of health care assurance; and

(3) The supplier is registered to do business in the State.

§321-E Annual inspection. (a) The office of health care assurance shall perform an inspection of all suppliers who intends to participate in the nationwide competitive bidding program.

(b) The inspection shall consist of:

(1) Confirmation that the supplier maintains an appropriate physical location within the State;

(2) Confirmation that the supplier maintains a working local telephone number;

(3) Confirmation that a full-time employee is available to Hawaii residents during normal local business hours to answer customer inquiries; and

(4) Confirmation that the supplier is registered with the department of commerce and consumer affairs to do business in the State.

§321-F License fees. A fee of $ per licensing year shall be assessed on each supplier. The license fees collected shall be deposited in the health care assurance special fund pursuant to section 321-1.4.

§321-G Supplier duties. (a) A supplier and its agents shall have a good faith duty to comply with the annual inspection performed by the office of health care assurance.

(b) A supplier shall register its business with the business registration division of the department of commerce and consumer affairs and shall provide a copy of a current business registration to the office of health care assurance during its annual inspection.

§321-H Severability. If any provision of this part or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect the other provisions or application, and to this end the provisions of this part are severable."

SECTION 4. Section 321-1.4, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) There is established within the department of health, to be administered by the department of health, the office of health care assurance special fund into which shall be deposited moneys collected under section 321-11.5(b), license fees for the administration of the supplier of durable medical equipment licensing program collected pursuant to section 321-F, and all administrative penalties imposed and collected by the office of health care assurance pursuant to section 321-20.

(b) Moneys in the special fund shall be expended by the department of health:

(1) To assist in offsetting operating costs and educational program expenses of the department of health's office of health care assurance; and

(2) For the purpose of enhancing the capacity of office of health care assurance programs to:

(A) Improve public health outreach efforts, program and community development, and consultations to industries regulated; [~~and~~]

(B) Educate the public, the staff of the department of health, [[]and[]] other departments within the State, as well as staff and providers of all health care facilities and agencies regulated[.]; and

Not more than [~~$300,000~~] $ of the special fund may be used during any fiscal year for the activities carried out by the office of health care assurance."

SECTION 5. The enactment of this chapter shall be exempt from the requirements of chapter 26H-6.

SECTION 6. There is appropriated out of the office of health care assurance special fund the sum of $ or so much thereof as may be necessary for fiscal year 2015-2016 and the same sum or so much thereof as may be necessary for fiscal year 2016-2017 for expenses incurred by the office of health care assurance to fill one full-time equivalent (1.0 FTE) position to establish and administer the durable medical equipment licensing program.

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

SECTION 7. This Act shall take effect on July 1, 2015.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	966
TWENTY-EIGHTH LEGISLATURE, 2015
STATE OF HAWAII