reglab/statecodes huggingface dataset:
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-43 Certificates of need.

§323D-43 Certificates of need.
(a) No person, public or private, nonprofit or for profit, shall:
(1) Construct, expand, alter, convert, develop, initiate, or modify a health care facility or health care services in the State that requires a total capital expenditure in excess of the expenditure minimum; or
(2) Substantially modify or increase the scope or type of health service rendered; or
(3) Increase, decrease, or change the class of usage of the bed complement of a health care facility, or relocate beds from one physical facility or site to another,
unless a certificate of need therefor has first been issued by the state agency.
(b) No certificate of need shall be issued unless the state agency has determined that:
(1) There is a public need for the facility or the service; and
(2) The cost of the facility or service will not be unreasonable in the light of the benefits it will provide and its impact on health care costs.
(c) The state agency may adopt criteria for certificate of need review which are consistent with this section. Such criteria may include but are not limited to need, cost, quality, accessibility, availability, and acceptability.
Each decision of the state agency to issue a certificate of need shall, except in an emergency situation that poses a threat to public health, be consistent with the state health services and facilities plan in effect under section 323D-15. Each certificate of need issued shall be valid for a period of one year from the date of issuance unless the period is extended for good cause by the state agency and expenditures for the project shall not exceed the maximum amount of the expenditures approved in the certificate of need. [L 1975, c 159, pt of §2; am L 1977, c 178, pt of §2; am L 1980, c 75, §12; am L 1982, c 245, §5; am L 1984, c 267, §9; am L 1987, c 270, §11; am L 1997, c 336, §8]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-44.5 Administrative review of certain applications for certificate of need.

§323D-44.5 Administrative review of certain applications for certificate of need.
The state agency shall adopt rules in conformity with chapter 91 providing for administrative review and decision on certain applications for certificate of need. Each application reviewed under this section may be subject to a public information meeting before the state agency makes its decision. The agency, in the State and in the county affected, shall give public notice of applications for administrative review received by the agency. Interested persons may request in writing a public meeting before the agency renders a decision on the administrative application. If a request for a public meeting is received, the administrator will preside over the meeting. If no request is received by the agency within seven days of the public notice date, no public meeting need be scheduled. Applications subject to administrative review and decision under this section shall include but are not limited to applications that are:
(1) Inconsistent with or contrary to the state health services and facilities plan under section 323D-15;
(2) Determined not to have a significant impact on the health care system; or
(3) Involve capital or annual operating expenses below a significant level. [L 1987, c 270, pt of §2; am L 1989, c 254, §2; am L 1997, c 336, §10; am L 1998, c 2, §86]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-44.6 Review of certain applications for certificate of need; waiver.

§323D-44.6 Review of certain applications for certificate of need; waiver.
The subarea council, the review panel, and the statewide council may, at their discretion, choose to waive their respective prerogatives of review of any certificate of need application. [L 1987, c 270, pt of §2]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-45 Subarea council, review panel, and statewide council recommendations for issuance or denial of certificates of need.

§323D-45 Subarea council, review panel, and statewide council recommendations for issuance or denial of certificates of need.
(a) Except for an administrative review as provided in section 323D-44.5, or in an emergency situation or other unusual circumstances as provided in section 323D-44(c), the state agency shall refer every application for a certificate of need to the appropriate subarea council or councils, the review panel, and the statewide council. The subarea council and the review panel shall consider all relevant data and information submitted by the state agency, subarea councils, other areawide or local bodies, and the applicant, and may request from them additional data and information. The review panel shall consider each application at a public meeting and shall submit its recommendations with findings to the statewide council. The statewide council shall consider the recommendation of the review panel at a public meeting and shall submit its recommendations to the state agency within such time as the state agency prescribes. The statewide council and the review panel may join together to hear or consider simultaneously information related to an application for a certificate of need.
(b) At a public meeting in which a subarea council or the review panel considers an application for a certificate of need, any person shall have the right to be represented by counsel and to present oral or written arguments and evidence relevant to the application; any person directly affected by the application may conduct reasonable questioning of persons who make factual allegations relevant to the application; any staff member of the state agency may conduct reasonable questioning of persons who make factual allegations relevant to the application; and a record of the meeting shall be kept. [L 1975, c 159, pt of §2; am L 1977, c 178, pt of §2; am L 1980, c 75, §14; am L 1984, c 267, §11; am L 1987, c 270, §12]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-45.1 Ex parte contacts prohibited.

§323D-45.1 Ex parte contacts prohibited.
(a) There shall be no ex parte contacts:
(1) In the case of an application for a certificate of need, between the applicant for the certificate of need, any person acting on behalf of the applicant, any person in favor of the application or any person opposed to the issuance of a certificate of need and any person in the state agency who exercises any responsibility respecting the application, after the commencement of the state agency's review of the application and before the state agency makes a decision on the application, on any matter related to or arising out of the application for a certificate of need;
(2) In the case of a proposed withdrawal of a certificate of need, between the holder of the certificate of need, any person acting on behalf of the holder, any person opposed to the withdrawal or any person in favor of the withdrawal and any person in the state agency who exercises any responsibility respecting withdrawal of the certificate of need, after the commencement of state agency proceedings on the proposed withdrawal and before the state agency makes a decision on the proposed withdrawal, on any matter related to or arising out of the proposed withdrawal of the certificate of need; and
(3) In the case of an application for an exemption from obtaining a certificate of need, between the applicant for an exemption, any person acting on behalf of the applicant, any person in favor of the application or any person opposed to the application and any person in the state agency who exercises any responsibility respecting the application, after the commencement of the state agency's review of the application and before the state agency makes a decision on the application, on any matter related to or arising out of the application for an exemption from obtaining a certificate of need.
(b) The prohibition against ex parte contacts shall not apply to any written communication or a copy thereof which is promptly filed as a public record with the state agency. [L 1980, c 75, §15]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-45.3 Approval of applications required to meet safety, licensure, or accreditation standards.

§323D-45.3 Approval of applications required to meet safety, licensure, or accreditation standards.
(a) Notwithstanding section 323D-43, the state agency shall approve an application for a certificate of need for a capital expenditure which is required:
(1) To eliminate or prevent imminent safety hazards as defined by federal, state, or county fire, building, or life safety codes or regulations, or
(2) To comply with state licensure standards,
(3) To comply with accreditation standards, compliance with which is required to receive reimbursements under Title XVIII of the Social Security Act or payments under a state plan for medical assistance approved under Title XIX of such Act,
unless the state agency finds that the facility or service with respect to which the capital expenditure is proposed to be made is not needed or that the obligation of the capital expenditure is not consistent with the state health services and facilities plan in effect under section 323D-15.
(b) An application for a certificate of need approved by the state agency under this section shall be approved only to the extent that the capital expenditure is required to eliminate or prevent the hazards described in paragraph (1) or to comply with the standards described in paragraph (2) or (3). [L 1980, c 75, §17; am L 1982, c 245, §5; am L 1984, c 267, §13]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-46 Conditional certification.

§323D-46 Conditional certification.
The state agency shall provide by rules adopted in conformity with chapter 91 for the conditional certification of those proposals which, by modification of specific items of the proposal, would successfully meet the criteria for approval. The state agency shall establish a time period not to exceed one hundred fifty days from the date of the conditional certification within which the applicant shall certify to the state agency that the required modifications have been made. The state agency shall require a statement from the applicant certifying that the required modifications have been made before a certificate of need is issued. The state agency shall deny any application in which the required modifications have not been made within the time period established by the state agency. [L 1977, c 178, pt of §2; am L 1980, c 75, §18]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-46.2 Withdrawal of a certificate of need.

§323D-46.2 Withdrawal of a certificate of need.
(a) After the issuance of a certificate of need, the state agency shall periodically review the progress of the project. The state agency may withdraw the certificate of need, if the state agency determines on the basis of the review that:
(1) The holder of the certificate of need is not meeting the timetable specified in the approved application for the certificate of need and is not making a good faith effort to meet it; or
(2) The project being implemented differs substantially from that which was approved by the state agency.
(b) The state agency may withdraw at any time a certificate of need or an exemption from obtaining a certificate of need, if the state agency determines that the applicant procured the certificate of need or the exemption by fraud, misrepresentation, or corruption, or that the applicant submitted or caused to be submitted to the state agency false statements or information in connection with the application for the certificate of need or the exemption.
(c) The state agency shall adopt rules in conformity with chapter 91 for the withdrawal of certificates of need. [L 1980, c 75, §20]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-47 Request for reconsideration.

§323D-47 Request for reconsideration.
The state agency may provide by rules adopted in conformity with chapter 91 for a procedure by which any person may, for good cause shown, request in writing a public hearing before a reconsideration committee for purposes of reconsideration of the agency's decision. The reconsideration committee shall consist of the administrator of the state agency and the chairpersons of the statewide council, the review panel, the plan development committee of the statewide council, and the appropriate subarea health planning council. The administrator shall be the chairperson of the reconsideration committee. A request for a public hearing shall be deemed by the reconsideration committee to have shown good cause, if:
(1) It presents significant, relevant information not previously considered by the state agency;
(2) It demonstrates that there have been significant changes in factors or circumstances relied upon by the state agency in reaching its decision;
(3) It demonstrates that the state agency has materially failed to follow its adopted procedures in reaching its decision;
(4) It provides such other bases for a public hearing as the state agency determines constitutes good causes; or
(5) The decision of the administrator differs from the recommendation of the statewide council.
To be effective a request for such a hearing shall be received within ten working days of the state agency decision. A decision of the reconsideration committee following a public hearing under this section shall be considered a decision of the state agency for purposes of section 323D-44. [L 1977, c 178, pt of §2; am L 1987, c 270, §13; am L 1997, c 336, §11]
Case Notes
State health planning and development agency administrator was not disqualified from participating in the reconsideration of respondent's certificate of need pursuant to §11-1-25(a)(4), Hawaii administrative rules (HAR), which prohibits a hearings officer from hearing or deciding a contested case in which the hearings officer substantially participated in making the decision or action contested, given that in crafting this section, the legislature clearly intended that the administrator participate in both the initial decision on a certificate of need, and in any reconsideration of that decision. Further, because §11-1-25(a)(4), HAR, conflicts with that intent, it would be invalid if applied in the circumstances of this case, and thus was inapplicable. 130 H. 95, 306 P.3d 140 (2013).
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-48 Judicial review of state agency decisions.

§323D-48 Judicial review of state agency decisions.
(a) If an application for a certificate of need or for an exemption from obtaining a certificate of need is denied, the state agency shall give notice to the applicant in writing stating the grounds for the denial. Any person adversely affected by a final decision of the state agency with respect to a certificate of need or an application for an exemption may appeal in the manner provided in chapter 91 to the circuit court of the circuit in which the person resides or in the circuit in which the health care facility or health care service is or was planned to be located.
(b) Any person adversely affected by a final decision of the state agency with respect to the withdrawal of a certificate of need may appeal in the manner provided in chapter 91 to the circuit court of the circuit in which the person resides or in the circuit in which the health care facility or health care service is or was planned to be located. [L 1975, c 159, pt of §2; ren L 1977, c 178, pt of §2; am L 1980, c 75, §21]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-49 Certificates of need; licenses and permits.

§323D-49 Certificates of need; licenses and permits.
(a) No permit or license shall be issued by any county or state officer for the development, construction, expansion, alteration, conversion, initiation, or modification of a health care facility or health care service, other than an existing hospital, or for the operation of a new health care facility or health care service unless there is submitted in connection with the application for such permit or license a current certificate of need issued by the state agency or a statement issued by the state agency that the health care facility or health care service is not required to hold a certificate of need under this part.
(b) No building permit shall be issued by any county or state officer for the development, construction, expansion, alteration, conversion, initiation, or modification of an existing hospital unless there is submitted in connection with the application for such building permit a current certificate of need issued by the state agency or a statement issued by the state agency that the existing hospital is not required to hold a certificate of need under this part. [L 1975, c 159, pt of §2; ren and am L 1977, c 178, pt of §2; am L 2004, c 33, §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-50 Certificates of need, penalties.

§323D-50 Certificates of need, penalties.
(a) Any person who violates any provision of this part, or rules thereunder, with respect to the requirement for certificate of need shall be guilty of a misdemeanor for each seven-day period or fraction thereof that the violation continues. Each subsequent seven-day period shall constitute a separate offense.
(b) Any license to operate a health facility may be revoked or suspended by the department of health at any time in a proceeding before the department for any person proceeding with an action covered under section 323D-43 without a certificate of need. If any such license is revoked or suspended by the department, the holder of the license shall be notified in writing by the department of the revocation or suspension. Any license to operate a health facility that has been revoked under this section shall not be restored except by action of the department.
(c) Any person who violates any provision of this chapter or rules adopted under this chapter, with respect to the agency's requests for reporting, may be subject to an administrative penalty not to exceed $2,000 for each seven-day period or fraction thereof that the violation continues. The administrator of the state agency may impose the administrative penalty specified in this section by order; provided that no penalty shall be assessed unless the person charged shall have been given notice and an opportunity for a hearing pursuant to chapter 91. The administrative penalty contained in the notice of finding of violation shall become a final order unless, within twenty days of receipt of the notice, the person charged makes a written request for a hearing. For any judicial proceeding to recover the administrative penalty imposed, the administrator need only show that notice was given, a hearing was held or the time granted for requesting a hearing has expired without such a request, the administrative penalty was imposed, and that the penalty remains unpaid. [L 1975, c 159, pt of §2; ren and am L 1977, c 178, pt of §2; am L 1997, c 336, §12]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-51 Injunctive relief.

§323D-51 Injunctive relief.
The state agency may, in the name of the people of the State through the attorney general of the State, apply for an injunction in any court of competent jurisdiction to enjoin any person who is not the holder of a certificate of need and who is not exempted from obtaining a certificate of need; and, upon the filing of a verified petition in the court, the court or any judge thereof, if satisfied by affidavit or otherwise, that the person is or has been proceeding with an action covered under section 323D-43 without a certificate of need, may issue a temporary injunction, without notice or bond, enjoining the defendant from further action. A copy of the verified complaint shall be served upon the defendant and the proceedings shall thereafter be conducted as in other civil cases. If it is established that the defendant has been or is proceeding with an action covered under section 323D-43 without a certificate of need, the court or any judge thereof may enter a decree enjoining the defendant from further action. In case of violation of any injunction issued under this section, the court may summarily try and punish the offender for contempt of court. The injunction proceeding shall be in addition to, and not in lieu of, all penalties and other remedies provided in this chapter. [L 1977, c 178, pt of §2; am L 1980, c 75, §22]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-52 Letters of intent.

§323D-52 Letters of intent.
Persons proposing construction projects shall submit to the state agency letters of intent in such detail as may be necessary to inform the agency of the scope and nature of the projects at the earliest possible opportunity in the course of planning of such construction projects. [L 1977, c 178, pt of §2]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-53 Periodic reports from health facilities.

§323D-53 Periodic reports from health facilities.
Any health facility or business subject to regulation under this part shall, at the request of the state agency, supply such information to the state agency as is necessary to carry out the purposes of this chapter, including but not limited to:
(1) Periodic reports from holders of certificates of need respecting the development of the proposals for which certificates have been issued,
(2) Master plans, feasibility studies, and other long-range plans and studies,
(3) Financial information, and
(4) Utilization information. [L 1977, c 178, pt of §2]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-61 Personnel.

Note
Part redesignated by L 1976, c 152, §2.
§323D-61 Personnel.
The administrator of the state agency shall hire necessary personnel under chapter 76 to carry out the purposes of this chapter. [L 1975, c 159, pt of §2; ree L 1977, c 178, pt of §2; am L 2000, c 253, §150]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-62 Rules.

§323D-62 Rules.
The state agency and the statewide health coordinating council may adopt necessary rules for the purposes of this chapter in accordance with chapter 91. [L 1975, c 159, pt of §2; am L 1977, c 178, pt of §2; am L 1980, c 75, §25]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-71 Definitions.

§323D-71 Definitions.
For the purpose of this part, unless the context requires otherwise:
"Acquisition" means any acquisition by a person or persons of an ownership or controlling interest in a hospital, whether by purchase, merger, lease, gift, or otherwise, that results in a change of ownership or control of twenty per cent or greater or which results in the acquiring person or persons holding a fifty per cent or greater interest in the ownership or control of that hospital.
"Agency" means the state health planning and development agency.
"Hospital" means an institution with an organized medical staff, regulated under section 321-11(10) which admits patients for inpatient care, diagnosis, observation, and treatment, but does not include a public health facility under chapter 323F.
"Person" has the meaning found in section 323D-2. [L 1998, c 257, pt of §1; am L 2001, c 69, §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-72 Acquisition of hospital.

§323D-72 Acquisition of hospital.
(a) No person shall engage in the acquisition of a hospital without first:
(1) Applying for and receiving the approval of the agency; and
(2) Notifying the attorney general and, if applicable, receiving approval from the attorney general pursuant to this part.
(b) Any person not required to obtain the approval of the agency under this part shall give the attorney general at least ninety days prior notice of an impending acquisition, during which time the attorney general may take any necessary and appropriate action consistent with general duties of oversight with regard to the conduct of charities, if applicable. The notice shall briefly describe the impending acquisition, including any change in ownership of tangible or intangible assets.
(c) The application shall be submitted to the agency and the attorney general on forms provided by the agency and shall include:
(1) The name of the seller, the name of the purchaser, and the names of other parties to an acquisition;
(2) The terms of the proposed agreement;
(3) The sale price;
(4) A copy of the acquisition agreement;
(5) A financial and economic analysis and report from an independent expert or consultant of the effect of the acquisition under the criteria set forth in section 323D-76; and
(6) All other related documents.
A copy of the application and copies of all additional related materials shall be submitted to the agency and to the attorney general at the same time. The applications and all related documents shall be considered government records. [L 1998, c 257, pt of §1; am L 2001, c 69, §2]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-73 Notice; procedures.

§323D-73 Notice; procedures.
(a) Within five working days after receipt of a complete application under section 323D-72, the agency shall give public notice of the application in the affected county or counties where the hospital is located and shall notify by first-class mail any person who has requested notice of the filing of such applications. The public notice shall state that a completed application has been received, state the names of the parties to the agreement, describe the contents of the application, and state the date by which a person may submit written comments about the application to the agency.
(b) Within ninety days after receiving a complete application, the agency shall review the application in accordance with the standards set forth in this part and approve or disapprove the acquisition.
Within twenty days after receiving a complete application, the attorney general shall determine whether a review of the application in accordance with section 323D-76 is appropriate and notify the applicant if a review is warranted. If the attorney general determines that a review is unnecessary or not appropriate, then none of the other provisions of this part applicable to review by the attorney general shall apply.
(c) For acquisitions which require approval from the agency under this part and a certificate of need, the applicant shall submit a single application for both purposes and the application shall be reviewed under a single unified review process by the agency. Following the single unified review process, the agency shall simultaneously issue its decision regarding the certificate of need and its decision for purposes of the sale of a hospital under this part. [L 1998, c 257, pt of §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-74 Hearings.

§323D-74 Hearings.
(a) The agency, after consultation with the attorney general, shall, if appropriate, hold a public hearing during the course of review, which hearing may be held jointly with the certificate of need review panel or the statewide health coordinating council, and in which any person may file written comments and exhibits or appear and make a statement. The agency or the attorney general may subpoena additional information or witnesses, require and administer oaths, require sworn statements, take depositions, and use related discovery procedures for purposes of the hearing and at any time prior to making a decision on the application.
(b) The hearing shall be held no later than sixty days after receipt of a complete application. The hearing shall be held upon ten working days notice, not including days the application is deemed to be incomplete. [L 1998, c 257, pt of §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-75 Review; decision; rules.

§323D-75 Review; decision; rules.
(a) The attorney general shall conduct its review of the application in accordance with the standards enumerated in section 323D-76. Within ninety days after receipt of an application, the attorney general shall review and approve or disapprove the acquisition.
(b) If the attorney general does not act within ninety days after receipt of an application, the application shall be deemed approved. If the attorney general approves or disapproves the acquisition, the applicant, or any person who has submitted comments and has a legal interest in the hospital being acquired or in another hospital that has contracted with the acquired hospital for the provision of essential health services, may bring an action for declaratory judgment for a determination that the acquisition is or is not in the public interest under the criteria set forth in section 323D-76.
(c) The agency shall review the completed application in accordance with the standards enumerated in section 323D-77. Within ninety days after receipt of a completed application, the agency shall:
(1) Approve the acquisition, with or without any specific modifications; or
(2) Disapprove the acquisition.
The agency shall not make its decision subject to any condition not directly related to criteria enumerated in section 323D-77, and any condition or modification shall bear a direct and rational relationship to the application under review.
(d) Any affected person may appeal a final decision by the agency to the reconsideration committee created under section 323D-47 under procedures substantially similar to those for appeals of health care certificate of need decisions. The reconsideration committee shall have the same powers and duties with respect to appeals under this part as exist for appeals to the reconsideration committee regarding issuance of certificates of need. The findings, conclusions, and decisions of the reconsideration committee shall constitute the determination of the agency. The agency, the applicant, or any affected person who has intervened in the matter before the reconsideration committee may seek judicial review of any agency determination.
(e) If both the agency and the attorney general review the application, it shall not be granted unless it is approved by both. [L 1998, c 257, pt of §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-76 Acquisition in the public interest; decision of attorney general.

§323D-76 Acquisition in the public interest; decision of attorney general.
If the attorney general determines that a review of the application is appropriate, the attorney general shall approve the application unless the attorney general finds that the acquisition is not in the public interest. An acquisition of a private nonprofit hospital is not in the public interest unless appropriate steps have been taken to safeguard the value of charitable assets and ensure that any proceeds of the transaction are used for appropriate charitable health care purposes as provided in paragraph (8). In determining whether the acquisition meets such criteria, the attorney general shall consider, as applicable:
(1) Whether the acquisition is permitted under chapter 414D governing nonprofit entities, trusts, or charities;
(2) Whether the hospital acted in a duly diligent manner in deciding to sell, selecting the purchaser, and negotiating the terms and conditions of the sale;
(3) The procedures used by the seller in making its decision, including whether appropriate expert assistance was used;
(4) Whether all conflicts of interest were disclosed, including, but not limited to, conflicts of interest related to board members of, executives of, and experts retained by the seller, purchaser, or parties to the acquisition;
(5) Whether the seller will receive reasonably fair value for its assets. The attorney general may employ, at the seller's expense, reasonably necessary expert assistance in making this determination;
(6) Whether charitable funds are placed at unreasonable risk, if the acquisition is financed in part by the seller;
(7) Whether any management contract under the acquisition is for reasonably fair value;
(8) Whether the sale proceeds will be used for appropriate charitable health care purposes consistent with the seller's original purpose or for the support and promotion of health care in the affected community, and will be controlled as charitable funds independent of the purchaser or parties to the acquisition; and
(9) Whether a right of first refusal to repurchase the assets by a successor nonprofit corporation or foundation has been retained, if the hospital is subsequently sold to, acquired by, or merged with another entity. [L 1998, c 257, pt of §1; am L 2002, c 40, §10]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-77 Acquisition; decision by agency.

§323D-77 Acquisition; decision by agency.
In making a decision whether to approve or disapprove an application, the agency shall consider:
(1) Whether sufficient safeguards are included to ensure that the affected community has continued access to affordable care;
(2) Whether the purchaser and parties to the acquisition have made a commitment to provide health care to the disadvantaged, uninsured, and underinsured, and to provide benefits to the affected community to promote improved health care. Current and prior health care activities and funding for those activities by the seller or its successor nonprofit corporation or foundation may be considered in evaluating compliance with this commitment;
(3) If health care providers will be offered the opportunity to invest or own an interest in the purchaser or a related entity to the purchaser; and
(4) Whether procedures or safeguards are in place to avoid conflict of interest in patient referral and the nature of those procedures or safeguards.
This section does not apply higher standards to hospitals covered by this part than those applicable to hospitals not covered by this part. [L 1998, c 257, pt of §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-78 Revocation; hearing.

§323D-78 Revocation; hearing.
If the agency receives information indicating that the acquiring person is not fulfilling the commitment to the affected community under section 323D-77, the agency shall hold a hearing upon ten days notice to the affected parties. If after the hearing the agency determines that the information is true, the department may institute proceedings to revoke the license issued to the purchaser. [L 1998, c 257, pt of §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-80 License renewal.

§323D-80 License renewal.
No license to operate a hospital may be issued or renewed by the department of health pursuant to this chapter, and a license which has been issued shall be subject to revocation or suspension, if:
(1) There is an acquisition of a hospital without first having received the approval of the agency under this part;
(2) There is an acquisition of a hospital without the approval of the attorney general, if the attorney general determines that a review of the application is appropriate under this part;
(3) There is an acquisition of a hospital and the attorney general disapproves the acquisition and there is a judicial determination that the acquisition is not in the public interest; or
(4) The hospital is not fulfilling its commitment under section 323D-77 or is not following procedures or safeguards required under section 323D-77(4).
This section does not limit the right to a hearing or the right of appeal for a hospital from such decision. [L 1998, c 257, pt of §1]
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-81 Prior acquisitions.

§323D-81 Prior acquisitions.
Any acquisition of a hospital before July 20, 1998 and any acquisition in which an application for a certificate of need has been granted by the agency before July 20, 1998 is not subject to this part. [L 1998, c 257, pt of §1]
Revision Note
"July 20, 1998" substituted for "the effective date of this part".
2023 Hawaii Revised Statutes › Title 19. Health › 323D. Health Planning and Resources Development and Health Care Cost Control › 323D-82 Maintenance of services.

§323D-82 Maintenance of services.
A person who has acquired or is engaged in the acquisition of a hospital shall not substantially reduce or eliminate direct patient care services at the hospital below the levels at which those services were available at the time of the acquisition, without first giving written notice of the planned reduction or elimination to the agency and receiving the agency's approval, prior to implementing the reduction or elimination of services. [L 1998, c 257, pt of §1; am L 1999, c 18, §6]
2023 Hawaii Revised Statutes › Title 19. Health › 323F. Hawaii Health Systems Corporation › 323F-1 Definitions.

§323F-1 Definitions.
As used in this chapter, unless the context otherwise requires:
"Consumer" means any individual who may utilize a Hawaii health systems facility for health services and is not a provider.
"Corporation" means the body corporate and politic known as the Hawaii health systems corporation.
"Corporation board" means the board of directors of the corporation.
"Department" means the department of health.
"Director" means the director of health.
"Division" means the programs, services, and facilities operated by the department of health, division of community hospitals, prior to the transfer date.
"Health facility" means any one of the facilities that constitute the division of community hospitals.
"Health systems assets" means all property or rights in property, real, personal and mixed, tangible or intangible, existing on the transfer date, used by or accruing to the division in the normal course of its operations.
"Provider" means any supplier of medical or health care goods and services of the type provided at a Hawaii health systems facility.
"Regional system board" means a community-based governing board of directors of a regional system of the corporation.
"Transfer date" means a date agreed to by the department and the corporation for the transfer of health systems assets to and the assumption of health systems liabilities, which includes without limitation, all debts or other obligations, contingent or certain, owing on such date, by the corporation. [L 1996, c 262, pt of §2; am L 2007, c 290, §17]
2023 Hawaii Revised Statutes › Title 19. Health › 323F. Hawaii Health Systems Corporation › 323F-2 Hawaii health systems corporation.

§323F-2 Hawaii health systems corporation.
(a) There is established the Hawaii health systems corporation, which shall be a public body corporate and politic and an instrumentality and agency of the State. The corporation shall be placed within the department of health for the administrative purposes specified in section 26-35(a)(6) only.
(b)
[Subsection effective until December 30, 2025. For subsection effective December 31, 2025, see below. L 2022, c 150,
§2(5).]
The corporate organization shall be divided into five regional systems, as follows:
(1) The Oahu regional health care system;
(2) The Kauai regional health care system;
(3) The Maui regional health care system;
(4) The east Hawaii regional health care system, comprising the Puna district, north Hilo district, south Hilo district, Hamakua district, and Kau district; and
(5) The west Hawaii regional health care system, comprising the north Kohala district, south Kohala district, north Kona district, and south Kona district;
and shall be identified as regional systems I, II, III, IV, and V, respectively.
(b)
[Subsection effective December 31, 2025. For subsection effective until December 30, 2025, see above. L 2022, c 150,
§2(5).]
The corporate organization shall be divided into four regional systems, as follows:
(1) The Kauai regional health care system;
(2) The Maui regional health care system;
(3) The east Hawaii regional health care system, comprising the Puna district, north Hilo district, south Hilo district, Hamakua district, and Kau district; and
(4) The west Hawaii regional health care system, comprising the north Kohala district, south Kohala district, north Kona district, and south Kona district;
and shall be identified as regional systems I, II, III, and IV, respectively. [L 1996, c 262, pt of §2; am L 2004, c 16, §5; am L 2007, c 290, §18; am L 2021, c 212, §2]
Note
Section reproduced to correct printing error in main volume.
2023 Hawaii Revised Statutes › Title 19. Health › 323F. Hawaii Health Systems Corporation › 323F-4 Board meetings.

§323F-4 Board meetings.
(a) The corporation board and each regional system board shall be exempt from part I of chapter 92 and shall meet no fewer than four times a year; provided that the regional system boards and the corporation board shall meet together at least once a year. Each regional board shall meet at least six times each year; provided that two of these meetings shall be public community meetings for the purpose of informing the community and taking comment on the regional system's performance if these meetings are in addition to the four board meetings. The public community meetings shall be advertised in a newspaper of general circulation in the regional system at least two weeks in advance.
(b) All business of the corporation board and each regional system board shall be conducted at a regular or special meeting at which a quorum is present, consisting of at least a majority of the directors then in office. The corporation board and each regional system board shall adopt procedural rules for meetings, not subject to chapter 91, that shall include provisions for meetings via electronic and telephonic communications and other methods that allow the boards to conduct business in a timely and efficient manner. Any action of the corporation board or each regional system board shall require the affirmative vote of a majority of those present and voting at the meeting; except that a vote of two-thirds of the entire membership of the respective board then in office shall be required for any of the following actions:
(1) Removal by the corporation board or respective regional system board of one of its members;
(2) Amendment by the corporation or a regional system board of its bylaws;
(3) Hiring or removing a regional chief executive officer;
(4) Filling of vacancies on a board; and
(5) Any other actions as provided by the corporation or regional system board bylaws, except the hiring or removing of the chief executive officer of the corporation. [L 1996, c 262, pt of §2; am L 1998, c 229, §5; am L 2007, c 290, §20; am L 2009, c 182, §11]
2023 Hawaii Revised Statutes › Title 19. Health › 323F. Hawaii Health Systems Corporation › 323F-4.5 Captive insurance board.

§323F-4.5 Captive insurance board.
(a) There is established a ten-member captive insurance board that shall carry out the corporation's duties and responsibilities relating to the establishment of any captive insurance company pursuant to section [323F-7(c)(20)] and the operation thereof.
(b) Eight members of the captive insurance board shall be appointed by the governor as follows:
(1) Three members from a list of five persons submitted by the president of the senate; provided that at least one of these members shall have experience in the insurance industry and financial matters;
(2) Three members from a list of five persons submitted by the speaker of the house of representatives; provided that at least one of these members shall have experience in the insurance industry and financial matters; and
(3) Two members, one of whom shall be the chief executive officer or chief financial officer of an insurer licensed to do business in the State and shall serve as a nonvoting member.
The director of health or the director's designee and the insurance commissioner or the commissioner's designee shall serve as ex officio, nonvoting members.
Any vacancy shall be filled in the same manner provided for the original appointments. The captive insurance board shall elect its own chair from among its members.
(c) The selection, appointment, and confirmation of any appointed nominee shall be based on ensuring that captive insurance board members have diverse and beneficial perspectives and experiences and that they include, to the extent possible, representatives of the insurance and/or finance sectors. Members of the captive insurance board shall serve without compensation but may be reimbursed for actual expenses, including travel expenses incurred in the performance of their duties.
(d) Any appointed member of the captive insurance board may be removed for cause by the governor or for cause by vote of a two-thirds majority of the captive insurance board members then in office. For purposes of this section, cause shall include without limitation:
(1) Malfeasance in office;
(2) Failure to attend regularly called meetings;
(3) Sentencing for conviction of a felony, to the extent allowed by section 831-2; or
(4) Any other cause that may render a member incapable or unfit to discharge the duties required under this chapter.
Filing nomination papers for elective office, appointment to elective office, or conviction of a felony consistent with section 831-3.1, shall automatically and immediately disqualify a board member from office.
(e) No member of the captive insurance board shall be an employee or vendor of the corporation, or an immediate family member thereof. For purposes of this subsection, "immediate family member" means a corporation board employee's or vendor's spouse, child, parent, grandparent, or any related individual who resides in the same household of the employee or vendor. [L 2007, c 278, §2]