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 D