REQUESTING THE DEPARTMENT OF HEALTH TO CONVENE A HOSPICE WORKING GROUP TO EXAMINE TRENDS AND REGULATIONS IN THE HOSPICE INDUSTRY.

HCR18

HOUSE OF REPRESENTATIVES

H.C.R. NO.

18

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

HOUSE CONCURRENT

RESOLUTION

requesting the
Department of Health to convene a hospice
working group to examine trends and regulations in the hospice industry
.

����
WHEREAS, hospice
is a form of health care for individuals with a terminal illness, typically
with a prognosis of six months or less to live, focusing on comfort, pain
relief, and quality of life; and

����
WHEREAS, in
1983, the Medicare Hospice Benefit was established by the Centers for Medicare
and Medicaid Services; and

����
WHEREAS, the
Medicare Hospice Benefit is robust, offering a flat rate between $154 and
$1,432 a day that covers all aspects of the patient's care, including all
services delivered by the interdisciplinary team, drugs, medical equipment, and
supplies; and

����
WHEREAS, a
study in 2013 conducted by Mount Sinai's Icahn School of Medicine found that
the hospice benefit saves money for Medicare and that the incremental effect in
cost between hospice and non-hospice groups was between $2,561 and $6,430; and

����
WHEREAS, this
study also found that hospice enrollment is associated with fewer thirty-day
hospital readmissions, in-hospital deaths, and significantly fewer overall
hospital and intensive care unit days; and

����
WHEREAS, following
the creation of the Medicare Hospice Benefit, the number of hospices grew from
two hundred thirty-five in 1980 to approximately seventeen hundred in 1985,
over ninety percent of which were non-profit entities; and

����
WHEREAS, by
2022, the total number of hospices had grown to close to six thousand; and

����
WHEREAS, the
rapid growth of hospice providers has resulted in a proliferation of bad actors
and prompted an article in the Los Angeles Times entitled "
End-of-life
care has boomed in California. So has fraud targeting older Americans
",
which found that the rapid growth from 2010 to 2020 has created a "cottage
industry of illegal practices, including kickbacks to crooked doctors and
recruiters who zero in on prospective patients at retirement homes and other
venues"; and

����
WHEREAS, the
article additionally found that health outcomes worsened and "[s]atisfaction
surveys reported by hospices nationwide show that more than 80% of respondents
rate[d] their hospice as a 9 or 10 out of 10, but in L.A. County that figure
drop[ped] to 74%", a difference in margin of thousands of patients; and

����
WHEREAS, a
study published by the
Department of Business, Economic Development, and Tourism
in
conjunction with the University of Hawaii Economic Research Organization found
that by 2035, one in four people in Hawaii will be sixty years of age or older;
and

����
WHEREAS, the
study found that there is a need to build a stronger health care system to
prepare for the surge in the number of older residents; and

����
WHEREAS,
Hawaii has a limited number of hospices, with the Office of Health Care
Assurance showing thirteen hospices in the State; and

����
WHEREAS, examining
the national trends of the hospice industry and the hospice industry in Hawaii
will enable the State to better prepare for the needs of its aging population;

now, therefore,

����
BE IT
RESOLVED by the House of Representatives of the Thirty-third Legislature of the
State of Hawaii, Regular Session of 2026, the Senate concurring, that the
Department
of Health is requested to convene a Hospice Working Group to examine trends and
regulations in the hospice industry
; and

����
BE IT FURTHER
RESOLVED that the working group is requested to consist of the following
members:

����
(1)
�
The Director of Health, or the Director's
designee;

����
(2)
�
The Administrator of the State Health Planning
and Development Agency, or the Administrator's designee;

����
(3)
�
The Administrator for the Med-QUEST Division
of the Department of Human Services, or the Administrator's designee;

����
(4)
�
The Director of the Executive Office on Aging,
or the Director's designee; and

����
(5)
�
Five members of hospices in operation in
Hawaii since before the year 2000, to be selected and invited to participate by
the Director of Health, as follows:

���������
(A)
�
Two organizations serving the City and County
of Honolulu;

���������
(B)
�
One organization serving the County of Kauai;

���������
(C)
�
One organization serving the County of Maui;
and

���������
(D)
�
One organization serving the County of Hawaii;
and

����
BE IT FURTHER
RESOLVED that the Hospice Working Group is requested to, at a minimum:

����
(1)
�
Study trends among the hospice industry
nationally and in Hawaii;

����
(2)
�
Examine the existing statutory and
administrative rules and regulations for Hawaii's hospice industry; and

����
(3)
�
Provide recommendations on regulatory changes
to ensure a continued high quality of care while meeting demand as demographics
change, including in rural and underserved communities; and

����
BE IT FURTHER
RESOLVED that the Hospice Working Group is requested to submit a report of its
findings and recommendations, including any proposed legislation, to the
Legislature no later than twenty days prior to the convening of the Regular
Session of 2027; and

����
BE IT FURTHER
RESOLVED that the working group is requested to dissolve on June 30, 2027; and

����
BE IT FURTHER
RESOLVED that certified copies of this Concurrent Resolution be transmitted to the
Director of Health, Administrator of the State Health Planning and Development
Agency, Administrator of the Med-QUEST Division of the Department of Human
Services, and Director of the Executive Office on Aging.

OFFERED BY:

_____________________________

Report Title:
�

DOH;
DHS; SHPDA; EOA; Hospice Working Group; Hospice Industry; Report