RELATING TO THE EMERGENCY MEDICAL SERVICES SPECIAL FUND.

Healthcare Taxes

Active

The official status still shows this bill as active or still awaiting another formal step.

Sponsor: KEOHOKAPU-LEE LOY, AMATO, BELATTI, GRANDINETTI, ILAGAN, KAHALOA, KAPELA, KILA, LOWEN, MARTEN, MIYAKE, MORIKAWA, OLDS, PERRUSO, POEPOE, QUINLAN, TAKAYAMA, TAKENOUCHI, TAM, TEMPLO
Last action: 2026-03-25
Official status: Report adopted; Passed Second Reading, as amended (SD 1) and referred to WAM.
Effective date: Not listed

Plain English Breakdown

The effective date of July 1, 3000, seems unusual and might be a placeholder.

Emergency Medical Services Special Fund Changes

This bill updates how money from emergency medical services payments can be deposited into the Emergency Medical Services Special Fund, changes its composition and allowable uses, sets a limit on unused funds, exempts certain expenditures from specific rules, and stops cigarette tax revenue from going to the fund starting in 2027.

What This Bill Does

Allows money from billable emergency medical services to be deposited into the special fund.
Changes how the fund is made up and what it can be used for.
Sets a limit on how much unused money can stay in the fund each year.
Exempts expenditures from the special fund from chapters 103D and 103F, HRS.
Stops cigarette tax revenue from going to the fund starting January 1, 2027.

Who It Names or Affects

Emergency medical services agencies and providers
The state treasury

Terms To Know

billable emergency medical services: Medical care that people pay for when they need urgent help.
special fund: A separate account where money is kept to be used for a specific purpose, in this case, emergency medical services.

Limits and Unknowns

The bill does not specify how the changes will affect current funding levels.
It is unclear what happens if the fund reaches its cap and there are still expenses to cover.
The effective date of July 1, 3000, seems unusual and might be a placeholder.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

HD1

Hawaii published version HD1

Plain English: This amendment allows revenues generated from billable emergency medical services to be deposited into a special fund dedicated to supporting these services in Hawaii.

Revenues from billable emergency medical services can now be deposited into the Emergency Medical Services Special Fund.
The composition and allowable uses of the special fund are being updated.
An annual cap on the special fund is established.

The exact details of how the new revenue structure will operate are not fully explained in the provided text.

SD1

Hawaii published version SD1

Plain English: The amendment updates how funds are deposited into and used from the Emergency Medical Services Special Fund by allowing billable emergency medical service revenues to be included in the fund and setting an annual cap on expenditures.

Allows revenue generated from billable emergency medical services to be deposited into the special fund.
Establishes a new annual expenditure cap for the special fund starting fiscal year 2021-2022.
Discontinues the allocation of cigarette tax revenues to the special fund beginning January 1, 2027.

The exact amount and composition of the annual expenditure cap are not specified in the amendment text.

Bill History

2026-03-25 S
Report adopted; Passed Second Reading, as amended (SD 1) and referred to WAM.
2026-03-25 S
Reported from HHS (Stand. Com. Rep. No. 3193) with recommendation of passage on Second Reading, as amended (SD 1) and referral to WAM.
2026-03-20 S
The committee(s) on HHS recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in HHS were as follows: 4 Aye(s): Senator(s) San Buenaventura, Kanuha, Keohokalole, Fevella; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) McKelvey.
2026-03-17 S
The committee(s) on HHS has scheduled a public hearing on 03-20-26 1:00PM; Conference Room 225 & Videoconference.
2026-03-10 S
Referred to HHS, WAM.
2026-03-06 S
Passed First Reading.
2026-03-06 S
Received from House (Hse. Com. No. 65).
2026-03-05 H
Passed Third Reading with none voting aye with reservations; none voting no (0) and Representative(s) Perruso excused (1). Transmitted to Senate.
2026-03-05 H
Reported from FIN (Stand. Com. Rep. No. 853-26), recommending passage on Third Reading.
2026-02-27 H
The committee on FIN recommend that the measure be PASSED, UNAMENDED. The votes were as follows: 15 Ayes: Representative(s) Todd, Takenouchi, Hartsfield, Hussey, Keohokapu-Lee Loy, Kitagawa, Kusch, Miyake, Morikawa, Perruso, Templo, Yamashita, Alcos, Gedeon, Reyes Oda; Ayes with reservations: none; Noes: none; and 1 Excused: Representative(s) Lee, M..
2026-02-24 H
Bill scheduled to be heard by FIN on Friday, 02-27-26 10:00AM in House conference room 308 VIA VIDEOCONFERENCE.
2026-02-18 H
Passed Second Reading as amended in HD 1 and referred to the committee(s) on FIN with Representative(s) Garcia, Pierick voting aye with reservations; none voting no (0) and none excused (0).
2026-02-18 H
Reported from HLT (Stand. Com. Rep. No. 346-26) as amended in HD 1, recommending passage on Second Reading and referral to FIN.
2026-02-11 H
The committee on HLT recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 9 Ayes: Representative(s) Takayama, Keohokapu-Lee Loy, Amato, Hartsfield, Marten, Olds, Takenouchi, Alcos; Ayes with reservations: Representative(s) Garcia; Noes: none; and Excused: none.
2026-02-06 H
Bill scheduled to be heard by HLT on Wednesday, 02-11-26 9:00AM in House conference room 329 VIA VIDEOCONFERENCE.
2026-01-28 H
Referred to HLT, FIN, referral sheet 3
2026-01-26 H
Introduced and Pass First Reading.
2026-01-23 H
Pending introduction.

Official Summary Text

RELATING TO THE EMERGENCY MEDICAL SERVICES SPECIAL FUND.
Emergency Medical Services Special Fund; Billable Emergency Medical Services; Allowable Uses
Amends the Emergency Medical Services Special Fund by authorizing the deposit of revenues from billable emergency medical services. Amends the composition and allowable uses of the special fund. Establishes a cap on the unencumbered and unexpended balance in the special fund. Exempts expenditures from the special fund from chapters 103D and 103F, HRS. Discontinues the allocation of cigarette tax revenues to the special fund beginning 1/1/2027. Effective 7/1/3000. (SD1)

Current Bill Text

Read the full stored bill text

HB1966

HOUSE OF REPRESENTATIVES

H.B. NO.

1966

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

relating
to the emergency medical services special fund
.

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

����
SECTION 1.
�
The legislature finds that the emergency medical
services special fund is a critical mechanism for supporting the delivery of
timely, high-quality emergency medical services across the State.
�
These services are essential to the health and
safety of Hawaii's residents and visitors, particularly given the State's
geographic isolation, rural communities, and reliance on coordinated emergency
response systems of care.

����
The legislature further finds that
the current statutory framework governing revenues deposited into the emergency
medical services special fund does not adequately reflect modern emergency
medical services operations, financing structures, or reimbursement models.
�
Emergency medical services agencies today
increasingly rely on billable revenue generated from the provision of medically
necessary emergency care to sustain staffing, equipment, training, data
systems, and system readiness.

����
The legislature recognizes that the emergency
medical services system generates an annual cash deposit of approximately $30,000,000
from health insurance reimbursement into the state general fund for services
provided in the counties of Hawaii, Kauai, and Maui.
�
Aligning the emergency medical services
special fund with contemporary, billable revenue-based funding mechanisms will
promote fiscal sustainability, transparency, and accountability, while ensuring
that funds generated through emergency medical services activities are
reinvested directly into the emergency medical systems of care.
�
Updating the revenue structure will strengthen
the State's ability to maintain consistent service levels, address workforce
challenges, and support continuous system improvements.

����
Accordingly, the purpose of this Act
is to modernize the emergency medical services special fund by:

����
(1)
�
Authorizing revenues derived from billable
emergency medical services to be deposited into the special fund;

����
(2)
�
Amending the composition and allowable uses of
the special fund; and

����
(3)
�
Establishing an annual cap on the special
fund.

����
SECTION
2
.
�
Section
321-232, Hawaii Revised Statutes, is amended by amending subsection (a) and (b)
to read as follows:

����
"(a)
�
The department shall establish reasonable
fees for services rendered to the public within the service area by the
department, any county within the service area, or private agency under this
part; provided that all revenues collected by the department and the respective
counties pursuant to this section shall be deposited into the state general
fund[
,
]
and the emergency medical services special fund,
except
amounts necessary to provide for collection services for bad debt
accounts.
�
Fees required to be set by
this section shall be established in accordance with chapter 91.

����
(b)
�

No ambulance
, community paramedicine, enhanced and expanded emergency
medical
services, or any other emergency medical services available from or
under the authority of this chapter shall be denied to any person on the basis
of the ability of the person to pay therefor or because of the lack of prepaid
health care coverage or proof of such ability or coverage."

����
SECTION
3
.
�
Section
321-234, Hawaii Revised Statutes, is amended to read as follows:

����
"
�321-234
�
Emergency medical
services special fund.
�
(a)
�
There is established within the state
treasury a special fund to be known as the emergency medical services special
fund to be administered and expended by the department.

����
(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)
�
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.

����
(c)
�

The special fund shall consist of:

����
(1)
�
No less than
fifty per cent of the emergency medical services revenue collected for services
provided pursuant to section 321-232;

����
(2)
�
Fees remitted
pursuant to section 249-31[
, cigarette
]
;

����
(3)
�
Cigarette

tax revenues designated under section 245-15[
, interest
]
;

����
(4)
�
Interest

and investment earnings attributable to the moneys in the special fund[
,
legislative
]
;

����
(5)
�
Legislative

appropriations, [
and grants,
]
including grants-in-aid; and

����
(6)
�
Grants,

donations, and contributions from private or public sources for the purposes of
the fund, shall be deposited into the special fund.

����
(d)
�

All unencumbered and unexpended moneys in excess of $45,000,000 remaining
on balance in the special fund at the close of June 30 of each year shall lapse
to the credit of the general fund.

����
(e)
�
The emergency medical services special fund
shall be used:

����
(1)
�
By the
department to support the continuing development and operation of a
comprehensive state emergency medical system of care;

����
(2)
�
To subsidize
the documented costs for the comprehensive emergency medical services,
including emergency ambulance, emergency air medical transport services,
equipment, supplies, training, education, dispatch, communications and data
systems, and public education of 911 emergency medical services; and

����
(3)
�
Necessary
administrative expenses, not to exceed five per cent of the total amount
collected in the special fund any given year.

����
(f)
�
Expenditures from the emergency medical
services special fund shall be exempt from chapters 103D and 103F.

����
[
(d)
]
(g)
�
The department shall submit an annual report
to the legislature no later than twenty days prior to the convening of each
regular session that outlines the receipts of, and expenditures from, the
special fund.

����
(h)
�
The department shall adopt rules pursuant to
chapter 91 to effectuate the purposes of this section.
"

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

����
SECTION 5.
�
This Act shall take effect on July 1, 2026.

INTRODUCED BY:

_____________________________

Report Title:

Emergency
Medical Services Special Fund; Billable Emergency Medical Services; Allowable
Uses

Description:

Amends
the Emergency Medical Services Special Fund by authorizing the deposit of
revenues from billable emergency medical services.
�
Amends the composition, allowable uses, and establishes
a cap on the special fund.

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