Health Care Professionals

Requires new legislation being considered for enactment that
seeks to change the scope of practice of a health care
professional to be referred to a review panel within the dept. of
commerce and consumer affairs for analysis.  Specifies
legislative policies and defines "health care professional".

HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that over the last few
 2 years, various groups of health care professionals have sought to
 3 extend the scope of their own practice or limit the scope of
 4 practice of other health care professionals.  Each time the scope
 5 of practice of a health care professional is modified, however,
 6 the legislature often becomes the referee between those groups
 7 whose practices potentially overlap and who have a great deal to
 8 win or lose in the outcome.
 9      The legislature finds, however, that it is more appropriate
10 for a panel of health care professionals within the department of
11 commerce and consumer affairs to first analyze the probable
12 effects of the proposed legislation and assess whether its
13 enactment is consistent with the various legislative policies,
14 similar to the process currently used under the Hawaii regulatory
15 licensing reform act for proposed legislation that would subject
16 unregulated professions and vocations to licensing or other
17 regulatory controls in section 26H-6, Hawaii Revised Statutes.
18      Accordingly, the purpose of this Act is to require the
19 director of commerce and consumer affairs to appoint one or more

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                                     H.B. NO.           

 1 review panels, each consisting of five health care professionals
 2 -- one who will advocate enactment of the proposed legislative
 3 measure under consideration, one who will oppose the measure, and
 4 three who can take a neutral stance -- to analyze and report on a
 5 measure that proposes to change the scope of practice of a health
 6 care professional.  The legislature will then be given an
 7 opportunity to review that analysis before deciding on the
 8 appropriateness of the measure.  The legislature finds that this
 9 approach will provide a more thoughtful, reasoned approach to a
10 discussion of the issues involved.
11      SECTION 2.  Chapter 451D, Hawaii Revised Statutes, is
12 amended by adding two new sections to be appropriately designated
13 and to read as follows:
14      "451D-A  Health care professionals; scope of practice;
15 analysis by the department of commerce and consumer affairs.  (a)
16 New measures being considered for enactment that, if enacted,
17 would change the scope of practice of a health care professional,
18 shall be referred for analysis to a health care professionals
19 review panel established in section 451D-B.  Referral shall be by
20 concurrent resolution that identifies a specific legislative bill
21 to be analyzed.  The analysis required by this section shall set
22 forth the probable effects of the proposed measure and assess
23 whether its enactment is consistent with the following policies:

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                                     H.B. NO.           

 1      (1)  Changes in the scope of practice of a health care
 2           professional shall be undertaken only where reasonably
 3           necessary to protect the health, safety, or welfare of
 4           consumers of the services; the purpose of the changes
 5           shall be the protection of the public welfare and not
 6           that of the regulated profession or vocation;
 7      (2)  Changes in the scope of practice of a health care
 8           professional shall be retained or adopted when the
 9           health, safety, or welfare of the consumer may be
10           jeopardized by the nature of the service offered by the
11           provider;
12      (3)  Evidence of abuses by providers of the service shall be
13           accorded great weight in determining whether changes in
14           the scope of practice of a health care professional are
15           desirable;
16      (4)  Changes in the scope of practice of a health care
17           professional which artificially increase the costs of
18           goods and services to the consumer shall be avoided
19           except in those cases where the legislature determines
20           that this cost is exceeded by the potential danger to
21           the consumer;
22      (5)  Changes in the scope of practice of a health care
23           professional shall be eliminated when the legislature

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 1           determines that they have no further benefits to
 2           consumers;
 3      (6)  Changes in the scope of practice of a health care
 4           professional shall not unreasonably restrict entry into
 5           those professions by all qualified persons; and
 6      (7)  Changes in the scope of practice of a health care
 7           professional shall not affect the fees imposed for the
 8           regulation of that profession except where necessary to
 9           cover additional costs of administering the program,
10           including additional testing costs.
11      (b)  The department, on behalf of a review panel, shall
12 submit each report of analysis, including the findings and
13 recommendations of the review panel and any proposed implementing
14 legislation, to the legislature no later than twenty days before
15 the convening of the next succeeding regular session of the
16 legislature, unless otherwise stated in the concurrent
17 resolution.
18      451D-B  Health care professionals review panels.  (a)  The
19 director of commerce and consumer affairs shall convene one or
20 more health care professionals review panels within the
21 department from time to time as needed, as provided in this
22 section.  Each review panel shall analyze and report on one or
23 more new measures being considered by the legislature pursuant to

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                                     H.B. NO.           

 1 section 451D-A that, if enacted, would change the scope of
 2 practice of a health care professional.
 3      (b)  Each review panel shall consist of the following five
 4 members to be appointed by the director of commerce and consumer
 5 affairs:
 6      (1)  One health care professional who advocates enactment of
 7           the proposed legislative measure under consideration;
 8      (2)  One health care professional who opposes enactment of
 9           the proposed legislative measure under consideration;
10           and
11      (3)  Three health care professionals who have taken a
12           neutral stance on the proposed legislative measure
13           under consideration.
14      (c)  The director shall appoint review panels to review each
15 legislative measure that proposes to change the scope of practice
16 of a health care professional; provided that the director may
17 consolidate several measures to be reviewed by one review panel
18 if those measures relate to the same or similar subject matter.
19      (d)  Each review panel shall meet as necessary during the
20 interim between regular sessions to consider the proposed
21 legislative measure under consideration.  Each review panel shall
22 submit its analysis and report to the department for submittal to
23 the legislature as provided in section 451D-A, and shall cease to

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                                     H.B. NO.           

 1 exist upon the filing of the report with the legislature, unless
 2 otherwise directed by the director.
 3      (e)  In carrying out its duties under this section, each
 4 review panel may request staff assistance from the department of
 5 commerce and consumer affairs.  The members of each review panel
 6 shall serve without compensation, but shall be reimbursed for
 7 expenses, including travel expenses, necessary for the
 8 performance of their duties."
 9      SECTION 3.  Section 451D-2, Hawaii Revised Statutes, is
10 amended as follows:
11      1.  By adding a new definition to be appropriately inserted
12 and to read:
13      ""Review panel" means the health care professionals review
14 panel established in section 451D-B."
15      2.  By amending the definition of "health care professional"
16 to read:
17      ""Health care professional" [includes physicians and
18 surgeons and others licensed pursuant to chapters 453 and 460,
19 podiatrists licensed pursuant to chapter 463E, dentists licensed
20 pursuant to chapter 448, psychologists licensed pursuant to
21 chapter 465, nurses licensed pursuant to chapter 457,
22 veterinarians licensed pursuant to chapter 471, acupuncturists
23 licensed pursuant to chapter 436E, massage therapists licensed

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                                     H.B. NO.           

 1 pursuant to chapter 452, naturopathic physicians licensed
 2 pursuant to chapter 455, chiropractors licensed pursuant to
 3 chapter 442, and pharmacists licensed pursuant to chapter 461.]
 4 means a person who is licensed, certified, or otherwise
 5 authorized or permitted by the laws of this State to administer
 6 health care in the ordinary course of business or practice of a
 7 profession, including any person who is licensed to provide
 8 health care services pursuant to:
 9      (1)  Chapter 436E (acupuncture practitioners);
10      (2)  Chapter 442 (chiropractic);
11      (3)  Chapter 447 (dental hygienists);
12      (4)  Chapter 448 (dentistry);
13      (5)  Chapter 451J (marriage and family therapists);
14      (6)  Chapter 452 (massage);
15      (7)  Chapter 453 (medicine and surgery);
16      (8)  Chapter 455 (naturopathy);
17      (9)  Chapter 457 (nurses);
18     (10)  Chapter 457G (occupational therapy practice);
19     (11)  Chapter 458 (opticians, dispensing);
20     (12)  Chapter 459 (optometry);
21     (13)  Chapter 460 (osteopathy);
22     (14)  Chapter 461J (physical therapy practice);
23     (15)  Chapter 463E (podiatrists);

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                                     H.B. NO.           

 1     (16)  Chapter 465 (psychologists);
 2     (17)  Chapter 466J (radiologic technology); and
 3     (18)  Chapter 468E (speech pathologists and audiologists)."
 4      SECTION 4.  In codifying the new sections added to chapter
 5 451D, Hawaii Revised Statutes, by section 2 of this Act, the
 6 revisor of statutes shall substitute appropriate section numbers
 7 for letters used in the designation of new sections.
 8      SECTION 5.  Statutory material to be repealed is bracketed.
 9 New statutory material is underscored.
10      SECTION 6.  This Act shall take effect upon its approval.
12                           INTRODUCED BY:  _______________________