Senate Health and Human Services committee advances broad package of health bills, debates telehealth and advance-directive language

The Senate Committee on Health and Human Services advanced a broad slate of health-related bills and amendments after public testimony and committee discussion, voting to pass measures that include proposed constitutional amendments on reproductive freedom and contraception, updates to telehealth law, pilot programs for houseless individuals with serious mental illness, and updates to advanced health-care-directive law.

The committee voted to pass chair recommendations on each measure; many votes were unanimous in committee, with one recorded excused absence. Members repeatedly said they would continue working on some items by inserting defect dates and asking for technical or non-substantive amendments.

Committee action and context

At the outset, the committee heard testimony on SB297, a proposed constitutional amendment described as protecting the right to reproductive freedom. Dozens of individuals and organizations filed testimony both supporting and opposing the measure. The committee adopted the chair's recommendation to pass SB297; the roll call in committee recorded the chair and vice chair voting aye, and Senators Hashimoto and Keohokalole voting aye; Senator Fevella was excused.

The committee also debated SB1281, a telehealth bill with significant stakeholder comment. HMSA (the Hawaii Medical Service Association) testified that it supported the bill's intent but opposed the draft because, it argued, the definition of an “interactive telecommunication system” could be read to expand audio-only telehealth beyond what federal rules will allow after the public-health emergency ends. An HMSA representative said the bill as written raised “great concerns” and asked for clarifying amendments. Department of Human Services and other advocates emphasized the need to preserve limited audio-only access in some rural and behavioral-health scenarios. The committee passed SB1281 with amendments that preserve audio-only language in certain places and set a defect date to allow continuing negotiation.

Committee members also advanced SB1450, an intensive mobile-teams pilot program for houseless individuals with serious mental-health disorders; the committee voted to pass with technical amendments, blanked out appropriations in the bill text and placed a request for $1,300,000 in the committee report. Bills to update home-care-agency standards (SB1438), nuisance authority for environmental public-health enforcement (SB1439), mental-health services for children and adolescents (SB1442), prior-authorization reporting requirements (SB1449), telepharmacy (SB1279), and several Medicaid and nursing-related bills also moved forward with technical edits, defect dates, or blanked appropriations for further negotiation.

A few items drew pointed testimony. Deputy Attorney General Aaron Lau and others told the committee that SB1323—revising statutory language on advanced health-care directives and adding model forms—would modernize and improve consistency; disability-rights advocates and other commenters raised concerns about a so-called “Ulysses clause” provision that some witnesses said could be used to permit involuntary medication without court process. Louis Erchick of the Hawaii Disability Rights Center said of that clause, “I cannot believe it's legal or constitutional.” The committee passed SB1323 with amendments and directed further work on specific language.

Votes at a glance (committee action)

- SB297 (constitutional amendment — reproductive freedom): Chair recommendation to pass as is; committee vote recorded aye (chair), aye (vice chair), aye (Hashimoto), aye (Keohokalole); Fevella excused. Outcome: passed in committee. - SB1438 (home care agencies): Chair recommendation to pass as is. Outcome: passed in committee. - SB1439 (nuisances / environmental health): Chair recommendation to pass with amendments (SD1). Outcome: passed in committee. - SB1441 (transition of Oahu Regional Healthcare System): Passed with amendments; committee directed non-substantive technical edits and removal of specific year references. - SB1442 (children and adolescent mental-health statute updates): Passed with technical amendments. - SB1443 (Department of Health-related measure): Passed as SD1 with technical amendments and a defect date noted where no testimony was filed. - SB1444 (general excise tax measure): Passed with technical amendments; Department of Taxation provided comments. - SB1445 (youth mental health): Passed with technical amendments; committee report includes appropriation notes ($500,000 for 2025–26 and $250,000 for 2026–27 recorded in the report). - SB1449 (prior authorization reporting): Passed with technical amendments and a defect date to allow the Department of Health to clarify requested amendments. - SB1450 (intensive mobile team pilot for houseless individuals): Passed with technical amendments; appropriation blanked in bill text and $1,300,000 listed in the committee report; defect date added (12/31/2050) to permit continuing work. - SB350 (constitutional amendment — right to contraception/SB350 per calendar language): Passed with technical amendments. - SB1596 (nursing-related updates, bill number SB1596 on calendar): Passed with amendments and changes to appropriation and responsible agency references; defect date added. - SB1565 (acupuncture recognition): Passed as introduced (committee accepted that it recognizes acupuncture scope); technical comments were solicited for draft amendments. - SB1564 (Medicaid-related changes): Passed with blanked appropriations; committee report noted $35,000,000 with a state/federal split described in the hearing as approximately $14.3 million state funds and $20.7 million federal funds; defect date added. - SB1418 (emergency appropriation to DHS): Passed with amendments consistent with Budget and Finance committee proposals. - SB1417 (crimes against protected service workers): Passed as introduced. - SB1411 (Medicaid third-party liability): Passed with technical amendments. - SB1399 (family-resilience pilot): Passed with a committee report request of $987,150 for a pilot program; bill advanced with blanked appropriations and defect date 12/31/2050. - SB1398 (trauma-informed care): Passed with committee-requested funding of $425,000 on the committee report and a defect date. - SB1323 (advanced health-care directives updates): Passed with amendments; committee accepted several technical edits, required removing one phrase and accepted several HHSC-proposed changes while adding a defect date to continue drafting model-form language. - SB1281 (telehealth updates): Passed with amendments to preserve limited audio-only telehealth language in specific locations and to add a defect date (12/31/2050) for continued negotiation; committee noted federal guidance (CMS) and Act 170 (2023) in discussion. - SB1279 (telepharmacy): Passed with PAC amendments; committee emphasized access for neighbor-island and rural communities.

What mattered in testimony

- Stakeholder alignment and remaining disagreement: Many professional associations (Hawaii Medical Association, Hawaii Primary Care Association, Queens Health Systems, John A. Burns School of Medicine leadership, Hawai‘i Medical Service Association/HMSA, and others) generally supported the bills’ objectives but asked for specific clarifications or alignment with upcoming federal CMS rules. Jonathan Ching (Kaiser Permanente) said, “we are in support of the reporting requirements, but we are asking it to be aligned to what we are submitting to the Center for Medicare and Medicaid, CMS itself.”

- Telehealth: Multiple witnesses and the insurer community warned that federal rules expected when the public-health emergency ends will limit audio-only telehealth in the home to a narrow set of behavioral-health and related assessments. HMSA urged alignment with CMS and preservation of stakeholder-negotiated reimbursement language from 2023. Committee amendments preserved some audio-only language in targeted places while adding a defect date for further negotiation.

- Advance directives and “Ulysses clause”: Several disability-rights and patient-advocacy witnesses opposed the inclusion or expansion of a so-called Ulysses clause in SB1323; Louis Erchick of the Hawaii Disability Rights Center called that clause into question, saying, “I cannot believe it's legal or constitutional.” The committee accepted amendments and directed continued drafting to clarify consent and surrogate-authority language.

Looking ahead

Committee members repeatedly inserted defect dates and blanked appropriations in bill text while placing dollar requests in the committee report; several items will return to committee or be reconciled during conference. The committee adjourned after completing decision-making on the calendar, with many measures advanced to the next legislative stage and several items left for further technical cleanup.

Ending note

Where testimony or exact statutory citations were not provided in committee materials at the hearing, the committee either inserted defect dates to continue work or asked agencies to provide revised draft language and justification in follow-up filings. The committee’s action advanced a broad health-policy package while signaling continued work on telehealth scope and protections in advance-directive forms.