HOUSE OF REPRESENTATIVES

H.B. NO.

2173

TWENTY-SIXTH LEGISLATURE, 2012

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to health.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature finds that changes in demographics, the delivery of health care services, and the escalating costs of education have resulted in a severe shortage of health care professionals in Hawaii.  A poor distribution of health care professionals has resulted in a surplus of these professionals in some areas of the State and a shortage in other parts, particularly in rural areas.  The rural shortage areas often require more services because the health care needs of residents in those areas are greater due to socio-economic or geographic circumstances.  Compounding this problem, it is difficult to recruit health care professionals to work in these areas because salaries are typically lower for health care professionals in shortage areas than non-shortage areas.

     The legislature also finds that two specific strategies would be successful in remedying health care shortages in Hawaii.  First, a loan repayment program made available to qualified physicians, dentists, and advanced care practitioners to repay their eligible educational loans in exchange for their commitment to practice in a healthcare professional shortage area would make it easier for physicians with high education debt to accept lower paying positions.  A loan repayment program can be structured to make use of available federal matching funds.

     Second, a recruitment program administered by the department of business, economic development, and tourism, would provide financial incentives to public and private nonprofit organizations, community health organizations, and eligible health professionals to provide health care services in specially designated shortage areas.  A successful recruitment program would be open to a wide variety of health care professionals, including mid-level practitioners, allied health professionals, and pharmacists, in addition to physicians and dentists.  Unlike the loan repayment program, the recruitment program would not use federal matching funds.

     The purpose of this Act is to create a loan repayment program and a recruitment program to attract and retain health care professionals in medically underserved areas of the State.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"CHAPTER

HAWAII HEALTH CORPS PROGRAM

PART I.  GENERAL PROVISIONS

     §   -1  Definitions.  As used in this chapter, unless the context clearly requires otherwise:

     "Applicant" means an individual who has submitted a completed application for the loan repayment program or the recruitment program and meets application requirements established by the department for the respective program.

     "Approved site" means, for the purposes of the loan repayment program, a provider site that is a public or nonprofit private entity located in a health professional shortage area and is approved by the department.

     "Dentist" means an individual licensed to practice dentistry in the State under chapter 448.

     "Department" means the department of business, economic development, and tourism.

     "Eligible education" means education and training programs approved by the department that lead to eligibility for licensure as a repayment health care professional.

     "Eligible expenses" means reasonable expenses associated with the cost of acquiring an eligible education, such as tuition, books, equipment, fees, room and board, and other expenses determined by the department.

     "Health professional shortage area" means a geographic area in the State determined by the department of health to have a shortage of health professionals.  In designating an area to be a health professional shortage area, the department of health may apply relevant federal standards.

     "Incentives" means cash or in-kind awards made to a recruitment recipient and includes awards made to a spouse or dependent of a recruitment health professional.

     "Loan repayment program" means the loan repayment program administered by the department.

     "Physician" means a person licensed under chapter 453.

     "Qualifying educational loan" means a government or commercial loan for eligible expenses.

     "Recruitment health professional" means an individual who is a health professional, including physicians, nurse practitioners, certified nurse-midwives, physician assistants, dentists, registered clinical dental hygienists, clinical or counseling psychologists, social workers, psychiatric nurse specialists, mental health counselors, licensed professional counselors, marriage and family therapists, and health care specialists.

     "Recruitment health professional shortage area" means a health professional shortage area or other area means a geographic area in the State determined by the department of health to have a shortage of recruitment health professionals.

     "Recruitment program" means the health professional recruitment and retention program.

     "Recruitment recipient" means either a recruitment health professional or a public or private nonprofit organization or community that employs a recruitment health professional.

     "Repayment health care professional" means a primary care physician, family care practitioner, internist, pediatrician, obstetrician, physician assistant, advance practice registered nurse, naturopathic physician, general psychologist, or general practice dentist.

     "Repayment participant" means a repayment health care professional who has received a loan repayment award and has commenced practice in a health professional shortage area.

PART II.  LOAN REPAYMENT PROGRAM

     §   -11  Loan repayment program established.  There is established the loan repayment program within the department of business, economic development, and tourism.  The loan repayment program shall be administered in a manner that is consistent with the provisions of Title 42 United States Code section 254q-1, as amended.

     §   -12  Administration.  The loan repayment program shall be administered by the department.  The department shall:

     (1)  Accept applications from interested persons;

     (2)  Develop criteria for the selection of repayment participants;

     (3)  Select repayment health care professionals to participate in the loan repayment program; provided that the department shall select no more than twenty repayment health care professionals in one year; provided further that no more than one hundred repayment health care professionals shall participate in the loan repayment program at any one time, subject to available funding and the need for repayment health care professionals in health professional shortage areas;

     (4)  Collect and manage repayments from repayment participants who do not meet their service obligations under this chapter, including enforcing applicable remedies for breach of a service obligation;

     (5)  Publicize and market the loan repayment program, particularly in a manner that maximizes participation in the program;

     (6)  Solicit and accept grants, donations, and other funding from public and private sources for the loan repayment program;

     (7)  Develop criteria for and enter into contracts with repayment participants that require repayment participants to complete their service obligation and comply fully with the terms and conditions of the loan repayment program;

     (8)  Administer the recruitment program separately from the loan repayment program under part III;

     (9)  Establish a working group, which shall be advisory only, comprising representatives from government and the health profession, including providers, community health centers, and professional organizations, to:

         (A)  Assist the department in developing criteria for selecting participants;

         (B)  Determine areas having the greatest need for health professionals; and

         (C)  Advise on other matters related to the administration of the loan repayment program;

          provided that working group members may also serve on the advisory group for the recruitment program under part III; and

    (10)  Take all other actions necessary to administer the loan repayment program.

     §   -13  Eligibility.  To be eligible to participate in the loan repayment program, an individual shall:

     (1)  Submit a completed application to the department;

     (2)  Have a signed employment agreement or contract with an approved site;

     (3)  Provide documentation of qualifying educational loans;

     (4)  Be a citizen of the United States;

     (5)  Be under no other contractual obligation to provide health professional services to the federal government, a state government, or other entity or organization, unless that obligation will be completely satisfied prior to entering into a contract to provide services under the loan repayment program;

     (6)  Have no judgments or liens for a debt owed to the United States;

     (7)  Have no history of failing to comply with or inability to comply with service or payment obligations;

     (8)  Have no history of default on any federal payment obligation, even if the creditor considers the obligation currently to be in good standing;

     (9)  Have breached no prior service obligation to the federal, state, or local government or other entity or organization, even if the obligation was subsequently satisfied;

    (10)  Have had no federal debt written off as uncollectible pursuant to Title 31 United States Code section 3711(a) or had no federal service or payment obligation waived;

    (11)  Agree to perform the service obligation at an approved site;

    (12)  Agree to provide full-time clinical services at an approved site;

    (13)  Agree to charge for the individual's professional services at the usual and customary prevailing rates in the area where the services are rendered; provided that if a patient is unable to pay the charge, the patient may be charged at a reduced rate or not charged for the services;

    (14)  Agree not to discriminate on the basis of a patient's ability to pay or on the basis that the payment for services will be made pursuant to medicare, medicaid, the state children's health insurance program, or any other public program;

    (15)  Agree to provide services to patients who are covered under medicare, medicaid, or the state children's health insurance program, and accept payments from those programs at the applicable rates of reimbursement for services;

    (16)  Agree to pay an amount as specified by the department for failure to complete the service obligation;

    (17)  Be a licensed and qualified repayment health care professional in the State and agree to maintain professional licensure and qualifications during the service obligation period;

    (18)  Agree to obtain and maintain any other licensure that may be required of repayment health care professionals in the State; and

    (19)  Meet any other requirements established by the department by rule.

     §   -14  Preference and selection.  (a)  In selecting repayment participants, the department shall give preference to the following, in order of priority:

     (1)  Graduates of the University of Hawaii John A. Burns School of Medicine;

     (2)  Graduates of out-of-state medical schools who are legal residents of Hawaii and are engaged in a medical residency program in Hawaii or otherwise practicing medicine in Hawaii; and

     (3)  Graduates of out-of-state medical schools who are graduates of high schools located in Hawaii and are engaged in a medical residency in Hawaii or otherwise practicing medicine in Hawaii.

     (b)  The department shall adopt rules pursuant to chapter 91 that establish criteria used to select repayment participants for the loan repayment program.  The criteria may include:

     (1)  The need for primary care physicians and dentists in health professional shortage areas;

     (2)  An applicant's willingness to work full-time in a health professional shortage area; or

     (3)  The likelihood of the applicant continuing to practice in a health professional shortage area after the service obligation has been completed.

     §   -15  Eligible expenses.  The department shall only repay qualifying educational loans.

     §   -16  Amount of the award.  Subject to the availability of funds and the need for repayment health care professionals in health professional shortage areas, the amount of an award made to a repayment participant for loan repayment shall be determined by the department; provided that the amount shall not exceed the maximum amounts permitted to be awarded to repayment participants under Title 42 United States Code section 254q-1, as amended.

     §   -17  Service obligation.  A repayment participant shall agree to serve full-time at an approved site for a minimum of two years, with an option to extend the service obligation for one-year terms for a total service obligation not to exceed five years.  Periods of internship, preceptorship, clinical training, or other postgraduate training shall not be counted toward the service obligation.

     §   -18  Cancellation of service obligation.  The department may cancel a contract with a repayment participant only upon the death of the repayment participant.

     §   -19  Waiver of service obligation.  The department may permanently waive a repayment participant's service obligation upon documentation that a medical condition or a personal situation makes compliance with the service obligation permanently impossible, as determined by the department.

     §   -20  Suspension.  The department may temporarily suspend a repayment participant's service obligation upon documentation by the repayment participant of a medical condition or personal situation that makes compliance with the service obligation temporarily impossible, as determined by the department.

     §   -21  Default.  A repayment participant who fails to complete the participants contractual service obligation shall be considered to be in default and shall pay to the department as a penalty the sum of the following:

     (1)  The loan repayment amount paid to or on behalf of a repayment participant for any period of obligated service not served;

     (2)  An amount equal to the number of months of obligated service not served multiplied by $7,500; and

     (3)  Interest on the above amounts at the maximum prevailing interest rate determined by the Treasurer of the United States from the day of the default;

provided that the amount that the department is entitled to collect shall not be less than $31,000.

     §   ‑22  Hawaii health corps first responder service obligation.  If an emergency proclaimed under section 127-10 or 128-7 occurs, physicians and dentists participating in the Hawaii health corps program may be ordered into service by the governor in areas of the State and in a capacity determined by the director.

     §   ‑23  Hawaii health corps special fund.  (a)  There is established within the state treasury the Hawaii health corps special fund to be administered and expended by the department.

     (b)  The special fund shall be used to provide stipends to qualifying Hawaii health corps physicians and dentists pursuant to this chapter.

     (c)  Moneys deposited into the special fund may include appropriations by the legislature, private contributions, stipend repayments, interest attributable to money deposited in the fund, and moneys allotted to the fund from other sources, which shall be accounted for separately.

     §   -24  Rules.  The department shall adopt rules pursuant to chapter 91 for the administration of the loan repayment program.

PART III.  RECRUITMENT PROGRAM

     §   -31  Established.  There is established the health professional recruitment and retention program within the department of business, economic development, and tourism.

     §   -32  Administration.  The recruitment program shall be administered by the department and shall:

     (1)  Maintain a list of communities and areas in the State that are determined to be recruitment health professional shortage areas;

     (2)  Maintain a list of recruitment health professionals who are interested in working in recruitment health professional shortage areas;

     (3)  Act as an intermediary between communities or public or private nonprofit organizations and recruitment health professionals willing to practice in recruitment health professional shortage areas;

     (4)  Work with communities and public or private nonprofit organizations to recruit and retain recruitment health professionals to work and live in recruitment health professional shortage areas;

     (5)  Assist recruitment health professionals to locate opportunities to work in recruitment health professional shortage areas;

     (6)  Develop funding models for the recruitment program that provide for financial security and medical practice location flexibility for recruitment health professionals;

     (7)  Develop incentives to support recruitment health professionals and their spouses, civil union patrons, reciprocal beneficiaries, or dependents, including but not limited to professional liability insurance relief, cost of living allowances, income guarantee payments, housing allowances, use of vehicles or vehicle allowances, continuing medical education, telemedicine capability, waiver of fees, or providing employment opportunities for the spouses, civil union patrons, reciprocal beneficiaries, of recruitment health professionals;

     (8)  Coordinate with other government agencies to minimize or remove regulatory barriers to relocating or practicing in health professional shortage areas;

     (9)  Select recruitment recipients using criteria established by the department;

    (10)  Publicize and market the recruitment program;

    (11)  Solicit and accept grants, donations, and other available moneys from public and private sources for the recruitment program;

    (12)  Administer the recruitment program separately from the loan repayment program, except to the extent provided in this chapter;

    (13)  Enter into contracts with recruitment recipients that obligate the recruitment recipients or recruitment health professionals to provide services in a recruitment health professional shortage area for the length of the service obligation;

    (14)  Establish an advisory group comprising representatives from government and the health profession, including providers, community health centers, and professional organizations, to:

         (A)  Assist the department in developing criteria to select recruitment health professionals;

         (B)  Identify areas having the greatest need for health professionals; and

         (C)  Advise on other matters related to the administration of the recruitment program;

          provided that advisory group members may also serve on the working group established under section    -12 for the loan repayment program; and

    (15)  Take all other actions necessary to administer the recruitment program.

     §   -33  Selection and preference.  (a)  In selecting recruitment recipients, the department shall give first priority preference to recruitment health professionals who are:

     (1)  Graduates of the University of Hawaii John A. Burns School of Medicine;

     (2)  Graduates of a medical residency program in Hawaii; or

     (3)  Legal residents of Hawaii who meet a minimum of three of the following criteria:

         (A)  The applicant has resided continuously in Hawaii for no less than the previous twelve months;

         (B)  The applicant's parents or legal guardians are legal residents of Hawaii;

         (C)  The applicant's place of birth is located in Hawaii;

         (D)  The applicant graduated from a high school located in Hawaii;

         (E)  The applicant is Hawaiian;

         (F)  The applicant graduated from a college or university located in Hawaii; or

         (G)  The applicant's parent or legal guardian is a graduate of the University of Hawaii John A. Burns School of Medicine or a medical residency program in Hawaii, or is a University of Hawaii John A. Burns School of Medicine faculty member.

     (b)  The department shall give second priority preference to recruitment health professionals who are graduates of out-of-state medical schools or medical residency programs.

     (c)  The department shall adopt rules pursuant to chapter 91 that establish criteria for selecting recruitment recipients.  The criteria may include:

     (1)  The need for recruitment health professionals in recruitment health professional shortage areas;

     (2)  An applicant's willingness to work full-time in a recruitment health professional shortage area; or

     (3)  The likelihood of the applicant continuing to practice in a recruitment health professional shortage area after the service obligation has been completed.

     §   -34  Award of incentives.  (a)  The department shall only award incentives to recruitment recipients.

     (b)  Subject to available funding and the need for recruitment health professionals in recruitment health professional shortage areas, the amount of incentives awarded to each recruitment recipient shall be determined by the department, provided that the amount shall not exceed $17,500 per recruitment recipient per year.

     §   -35  Eligibility.  (a)  The recruitment program shall accept applications from recruitment health professionals or public or nonprofit private entities or communities intending to employ or currently employing a recruitment health professional.

     (b)  To be eligible to participate in the recruitment program, a recruitment recipient shall:

     (1)  In the case of a public or nonprofit private entity or community, employ or intend to employ a recruitment health professional to provide professional health services in a recruitment health professional shortage area for the length of the service obligation; or

     (2)  In the case of a recruitment health professional, provide the services of the recruitment health professional in a recruitment health professional shortage area.

     (c)  In addition to any other recruitment program eligibility requirements in this section a recruitment health professional shall also:

     (1)  Be a citizen of the United States;

     (2)  Agree to provide full-time services of a recruitment health professional in a recruitment health professional shortage area;

     (3)  Agree to charge for the recruitment health professional's services at the usual and customary prevailing rates in the area where the services are provided; provided that if a patient is unable to pay the charge, the patient may be charged at a reduced rate or not charged for the services;

     (4)  Agree not to discriminate on the basis of a patient's ability to pay or on the basis that the payment for services will be made pursuant to medicare, medicaid, the state children's health insurance program, or any other public program;

     (5)  Agree to provide services to patients who are covered under medicare, medicaid, and the state children's health insurance program, and accept payments from those programs at the applicable rates of reimbursement for services;

     (6)  Agree to pay an amount as specified by the department to complete the service obligation;

     (7)  Be a licensed and qualified recruitment health professional in the State and agree to maintain applicable licensure and professional qualifications during the service obligation period;

     (8)  Agree to obtain and maintain any other licensure that may be required of recruitment health professionals in the State; and

     (9)  Meet any other requirements established by the department by rule.

     §   -36  Service obligation.  A recruitment recipient, in the case of a public or nonprofit private entity or community, shall obligate the recruitment health professional in its employ to practice full-time in a recruitment health professional shortage area for a minimum of two years, with an option to extend the service obligation for one-year terms for a total service obligation not to exceed five years.  Periods of internship, preceptorship, clinical training, or other post-graduate training shall not be counted toward the service obligation.

     §   -37  Recruitment health professional shortage areas.  Recruitment recipients shall be located in and shall provide services of a recruitment health professional in a recruitment health professional shortage area.

     §   -38  Waiver of service obligation.  The department may permanently waive a service obligation upon documentation by a recruitment health professional that a medical condition or a personal situation makes compliance with the service obligation permanently impossible, as determined by the department.

     §   -39  Suspension.  The department may temporarily suspend a service obligation upon documentation by a recruitment health professional of a medical condition or personal situation that makes compliance with the service obligation temporarily impossible, as determined by the department.

     §   -40  Default.  A recruitment recipient who fails to complete the recipient's contractual service obligation shall be considered to be in default and shall pay to the department as a penalty the sum of the following:

     (1)  The amount or value of incentives paid to or on behalf of a recruitment participant for any period of obligated service not served;

     (2)  An amount equal to the number of months of obligated service not served multiplied by $7,500; and

     (3)  Interest on the above amounts at the maximum prevailing interest rate determined by the Treasurer of the United States from the day of the default;

provided that the amount that the department is entitled to collect shall not be less than $31,000.

     §   -41  Rules.  The department shall adopt rules pursuant to chapter 91 for the administration of the recruitment program.

PART IV.  FIRST RESPONDERS

     §   -51  First responders.  All repayment participants and all recruitment health professionals participating in the recruitment program shall serve as first responders at the request of the governor or the director of health in the event of a declared emergency in the State pursuant to section 127-10 or 128-7.

PART V.  COORDINATION OF PROGRAMS

     §   -61  Coordination.  Notwithstanding any provision to the contrary, the department shall consider the overall need for both repayment health care professionals and recruitment health professionals in health professional shortage areas when selecting participants for the respective programs and placing participants in health professional shortage areas.

     §   -62  Coordination of funds.  Moneys appropriated by the legislature for the purposes of this chapter or received from private sources may be allocated by the department between the loan repayment program and the recruitment program based upon the funding needs of each program and the need for either repayment health care professionals or recruitment health professionals in the State."

     SECTION 3.  (a)  The department of business, economic development, and tourism shall implement the Hawaii health corps program no later than June 30, 2013.

     (b)  For the purposes of efficiency in the implementation of the program, the department shall award a minimum of thirty stipends of $30,000 per recipient in the first year of the program, an additional thirty stipends of $30,000 per recipient in the second year of the program, and an additional thirty stipends of $30,000 per recipient in the third year of the program.  In each year thereafter, the department shall award a maximum of one hundred stipends.

     (c)  The director of business, economic development, and tourism shall submit an annual report to the legislature on the status of the Hawaii health corps program, including any proposed legislation, no later than twenty days prior to the convening of the regular session of 2013 and each regular session thereafter.

     SECTION 4.  If any part of this Act is found to be in conflict with federal requirements that are a prescribed condition for the allocation of federal funds to the State, the conflicting part of this Act shall be inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and this finding shall not affect the operation of the remainder of this Act in its application to the agencies concerned.  Rules adopted pursuant to this Act shall meet federal requirements that are a necessary condition for the receipt of federal funds by the State.

     SECTION 5.  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 2012-2013 for the purposes this Act.

     The sum appropriated shall be expended by the department of business, economic development, and tourism for the purposes of this Act.

     SECTION 6.  This Act shall take effect on July 1, 2012.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Health; Loan Repayment; Recruitment; Hawaii Health Corps; Appropriation

 

Description:

Establishes the Hawaii health corps program.  Establishes a recruitment program and a loan repayment program to attract and retain qualified health professionals in medically underserved areas of the State.  Makes an appropriation.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.