REQUESTING THE DEPARTMENT OF HEALTH TO ASSESS THE SERVICES AND FUNDING NECESSARY TO ADDRESS THE NEEDS OF COMPLEX PATIENTS WHO HAVE TWO OR MORE DIAGNOSES THAT INCLUDE SUBSTANCE USE DISORDERS, MENTAL HEALTH DISORDERS, OR CHRONIC PHYSICAL ILLNESSES.

SCR149

THE SENATE

S.C.R. NO.

149

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

SENATE CONCURRENT

RESOLUTION

Requesting the Department of Health to establish an
informal working group to assess the services and funding necessary to address
the needs of complex patients who have at least two or more diagnoses that
include substance use disorders, mental health disorders, or chronic physical
illnesses
.

����
WHEREAS, the
Legislature finds that complex patients--those who have co-occurring substance
use disorders, mental health disorders, or chronic physical
conditions--represent a high‑need, high-cost population that requires a
modern, integrated care strategy; and

����
WHEREAS, complex
patients often cycle through fragmented and siloed health care systems that
fail to produce meaningful outcomes while generating high costs; leading to
frequent emergency room visits, hospitalizations, justice system involvement,
homelessness, and poor health outcomes; and placing an outsized burden on
social services, including Medicare and Medicaid; and

����
WHEREAS, approximately
fifty-four thousand adults in the State have chronic conditions of co-occurring
mental health and substance use disorders, often coupled with multiple chronic
physical illnesses, which, if left untreated, may become severe; and

����
WHEREAS, residential
and therapeutic living and intensive outpatient programs for complex patients
achieve better outcomes when conditions are treated simultaneously in
integrated care models that combine medical, behavioral, and social treatments
in coordinated care plans delivered by multidisciplinary teams; and

����
WHEREAS, the
establishment of an evidence-based pilot program would position Hawaii to
compete for federal grants; allow the alignment of Medicare and Medicaid
funding to support integrated services; and help close the gaps in care
services for complex patients; and

����
WHEREAS, the
infrastructure for offering integrated services currently exists, including
substance use disorder treatment models for which staff have the expertise to
treat both co-occurring severe mental health disorders and substance abuse
disorders; and

����
WHEREAS, some
substance abuse treatment programs use integrated models that also treat
chronic physical conditions of complex patients; and

����
WHEREAS, the Legislature
believes that it is time to end the fragmentation of care services by
developing integrated approaches to treat substance abuse disorders, mental
health disorders, and chronic illnesses in one setting; and

WHEREAS, integrated care
services would help improve engagement, lower relapse and hospitalization
rates, and support complex patients' long-term recovery; now, therefore,

����
BE IT
RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii,
Regular Session of 2026, the House of Representatives concurring, that the Department
of Health is requested to assess the services and funding necessary to address the
needs of complex patients who have at least two or more diagnoses that include
substance use disorders, mental health disorders, or chronic physical illnesses;
and

����
BE IT FURTHER
RESOLVED that the Department of Health is requested to establish an informal
working group consisting of relevant stakeholders, as determined by the
Department, to develop collaborative processes between the Department and other
appropriate agencies and organizations; and

����
BE IT FURTHER
RESOLVED that the informal working group is requested to consider:

����
(1)
�
The needs of complex patients, evidence-based
services available to address the needs of complex patients, and
recommendations for necessary funding to operate, or contract for the operation
of, one or more integrated residential treatment and therapeutic living
facilities to serve complex patients;

����
(2)
�
The feasibility of including medication-assisted
treatments and comprehensive substance use disorder treatments at residential
and therapeutic living facilities;

����
(3)
�
Recommended protocols for concluding mental
health evaluations, managing medications, offering psychotherapy, and stabilizing
patients in crisis; and

����
(4)
�
Recommendations for providing:

���������
(A)
�
On-site
or immediately available primary medical care and chronic disease management,
and for coordinating care with specialty medical providers;

����
����
(B)
�
Integrated nursing services;

����
����
(C)
�
Care coordination, case management, and
discharge planning services;

����
����
(D)
�
Peer support services;

����
����
(E)
�
Recovery-oriented, trauma-informed, and
culturally responsive programming;

����
����
(F)
�
A philosophy centered on the "pursuit of
abstinence" to improve functionality; and

����
����
(G)
�
Assistance with housing, employment, and
social determinants of health; and

����
BE IT FURTHER
RESOLVED that the Director of Health, or the Director's designee, is requested
to chair and convene the informal complex patients working group, consisting of
administrators or designees from various relevant state agencies, as determined
by the Director of Health; and

����
BE IT FURTHER
RESOLVED that the Director of Health or the Director's designee is requested to
invite members who could provide assistance or expertise to the working group,
including:

����
(1)
�
A representative from the Hawaii Substance Abuse Coalition;

����
(2)
�
Other substance use or mental health disorder providers;

����
(3)
�
Medical organization or agency representatives; and

����
(4)
�
Any other appropriate members, as determined by the Director of
Health; and

����
BE IT FURTHER
RESOLVED that the Department of Health is requested to submit a report of the
working group's 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 certified copies of this Concurrent Resolution be transmitted to the
Governor and Director of Health.

OFFERED BY:

_____________________________

Report Title:

DOH;
Complex Patients; Co-Occurring Multiple Diagnoses; Substance Use Disorders;
Mental Health Disorders; Chronic Physical Illness; Working Group