Government Relations, Ethics, and Transparency Committee - Regular Meeting

Will the government relations ethics and transparency committee meeting of 08/19/2025 please come to order? It is 01:34PM. Members, I am your chair, Nohelani Uhu Hajins. In accordance with the Sunshine Law, please identify by name who, if anyone, is in the room, vehicle, or workspace with you today. Minors do not need to be identified. Let's begin with committee vice chair Tomar Palton. Good afternoon.

Good afternoon, and aloha, we in a loss. Streaming live and direct from the historic burn zone. I have with me, Christian Balogso, and we have no testifiers waiting to testify at this time. Thank you.

Thank you very much. Good afternoon. Councilmember Cook.

Good afternoon, chair. There's no testifiers in the Key Regional Office, and I'm here and ready to work.

Thank you. I see I

you. Fascinating.

Let's hope. Councilmember Gabe Johnson, good afternoon.

Good afternoon, chair, council members, community members. I'm having a little Internet issues, so I had to step outside, outside alone, with no, testifiers at

the Lanai district office. Sorry if I'm coming in laggy.

You're good, actually, member Johnson, but thank you. I'll let you know if there's some moments of pause, but thank you for giving us the heads up. Council member Kama, good afternoon.

Good afternoon, chair, and aloha. To everyone. And I'm here ready to work.

Council chair Alice Lee, good afternoon. Good afternoon. Aloha. Member Rollins Fernandez on? I don't see her. Okay. She's excused for now. Councilmember Shane Senensi, good afternoon.

Hey. Good afternoon, chair. Aloha. Are no testifiers in honor, chair.

Thank you.

And thanks for bringing this up today.

Automatic. Councilmember Yukile Sugimura, good afternoon.

Good afternoon and looking forward to learning about this. Yeah, me too. Thank you, Member Senensi, for bringing it up.

Thank you. From corporation counsel, we have Mr. Thomas Colby, deputy corporation counsel. Our committee staff include Maria Leon, committee secretary, Casey Apo Takayama, senior legislative analyst, Clarissa McDonald, legislative analyst, Peter Hanano, legislative attorney, Leigh Deneen, council services clerk, and Jean Pokipala, council services assistance clerk. Please see the last page of the agenda for information on meeting connectivity. Do we have any testifiers? If not, I'm gonna save this whole log if in case we do. No, chair. There's currently no one

who has signed up to testify.

Okay. Let's begin with the first item on our agenda. We'll come back to testimony if we do have anybody waiting willing to testify. So as noted in my 06/16/2025 correspondence to this committee, the Hawaii State Association of Counties deadline to receive each county's 2026 HSAC legislative package proposals is 09/26/2025. Accordingly, August 8 was the deadline for the great committee to receive council members' proposals so that the committee can take its recommendations to the council before the deadline.

We have only received one proposal for each package, which is what we have agendized today. We have before us resolution 25 dash one five three entitled approving for the inclusion of the 2026 Hawaii State Association of Counties legislative package, a state bill relating to the psychology interjurisdictional compact. Thank you for the tongue twister, member Sanancy. The purpose of the proposed state bill is to create a new chapter in the Hawaii revised statutes for a psychology interjurisdictional compact, an interstate compact to facilitate the practice of telepsychology and the temporary in person practice of psychology across state boundaries to authorize the state to state practice of qualifying psychologists to help reduce regulatory barriers and allow more psychologists to practice in the state, thus improving access to essential mental health care. Before I turn over the floor to member Sanancy, the introducer of this resolution, I would like to note that this item as well as the next item, grade four two, pertain to the same bill.

Only difference is this one is the state version. The next one is the Maui version in the Maui County legislative package. If it's okay with the body, I would love to exhaust the discussion, in this next one, and we can save the Maui specific discussion for the next, bill. And this way, we can kind of move things along a little bit quicker. At this time, Member Senanci, if you have any opening comments, the floor is yours.

Mahalo Chair. Members, SciPact is an interstate compact designed to facilitate the practice of telepsychology, as the chair had mentioned. And the temporary in person face to face practice of psychology across state lines. The Association of State and Provincial Psychology Boards, ASPPB approved PSYPACT in 2015. PSYPACT aims to improve mental health services by promoting professional mobility for psychologists.

Members, licensed psychologists can become certified through PSYPACT once their state has joined PSYPACT. They can apply for an authority to practice interjurisdictional telepsychology, APIT, and an e passport certificate through the ASPPB. These certificates allow teletherapy practice across state lines and with clients in other CIPAC states. Psychologists can apply for an interjurisdictional practice certificate, an IPC, to provide temporary in person face to face clinical services in CIPAC participating states. An IPC allows psychologists to practice psychology for up to thirty days per year in CIPAC states without obtaining additional licenses.

To protect the public, CIPAC certifies that psychologists have met acceptable standards of practice. CIPAC also provides its participating states with mechanisms to address disciplinary issues that occur across state lines. SIPAC increases access to readily available mental health care. During COVID nineteen, psychologists use telehealth to respond to their increased demand. CIPAC also allows them to continue their virtual practice while reaching rural or underserved areas.

It also facilitates continuity of care for patients who travel out of state, allowing them to maintain access to their established provider. Members, House Bill eight thirty nine on 01/23/2025, House Bill eight thirty nine was introduced. It passed first reading and was

of

of the

of

the of it passed first reading. On January 16, it was referred to the Health and Human Services, Commerce and Consumer Protections, as well as the Ways and Means and judiciary committees. However, Senate Bill 32 has never received a hearing in committee. And so that's that's why we're here today. We're gonna try and introduce it again for the nest for the next, legislation. And chair, I did wanna say that, miss Janet Orwig from, SIPAC is also, on line to answer any questions for the members. Thank you.

Thank you, member Senanci. Yes. I will introduce her right after we do some more testimony. Do we have any other do we have, rather, any testifiers signed up?

Chair, there is no one who has signed up to testify.

Okay. Members, with your permission, I will close resolution testimony on resolution 25 dash one five three.

No objections.

Thank you. Without, objection, we closed it, and written testimony will continue to be accepted. To assist with any questions, as Member Sanancy noted, we have Ms. Janet Orwig, MBA CAE Executive Director of Psychology Interjurisdictional Compact, PSYCAP, joining us today. And with your permission, I would like to designate her, director Orwig, as a resource person under rule 18 a of rules of the council because of her special expertise in this matter. Thank you, members. She is so noted. If you do have any questions, I won't be going down the line. So please raise your hand if you have any questions for miss Orig or member Sanenci. Does anybody have any questions?

Member Sugimar, please go ahead.

Yeah. So I'm interested to know thank you very much, member Sanansi, for providing the history as it went through the legislature. Do you know in testimony what the challenges would be? Or maybe miss Erick Erick might be a resource for that, do you know why?

I know it was, I believe, introduced by Favela and Chang. Let me check my notes, but we did not, see any additional, like, discussions.

Oh, I see.

It just didn't receive the hearing.

Thank you. Just want to know what obstacles there are.

Thank you, Member Sigmaro. So, Member Senensi, how does this work? I, would be assigned a therapist, a doctor online. Is it am I prescribed somebody here and then they set me up with somebody virtually online? How does that work? Is it covered by insurance? Do you know?

I'll refer to Ms. Orwig.

Okay. Thank you. I would like to know how this works in other states and then how the Hawaii residents, if it does pass, would have access to telepsychology.

Good afternoon. Thank you very much for the time to visit with you today.

Doctor. Thank you very much.

Halena And I will try really hard to answer that question as easy as possible. Sometimes get down in the weeds, if I do, I apologize for that upfront. So how it works is it is volunteers. Psychologists apply for the authorization to the commission. So they apply and they are issued the authorization.

And then what happens there, it's up to the consumer of mental health services to locate a provider. We do have a directory where they can actually search for someone that may meet their special needs. They can search by the area of practice, languages spoken, areas served, population served, so that we are trying to make sure that authorized providers are matched up with the patients as that they can find their specific needs. It is voluntary. A psychologist does not have to participate.

So the way it works now, I am not a psychologist, but I'm going to pretend like I am going for this particular sample. And I live in Georgia in case you couldn't tell from my lovely accent here and I am sitting in Georgia. I have the authorization issued by the CIPAC commission and I am licensed here and I am able to provide services into other compact states. And there are 43 jurisdictions that have enacted the legislation, 42 of those are effective, Montana enacted this year and they will become effective on October 1. So I can provide services into Tennessee.

Let's say that or Alabama. So I'm sitting here in Georgia and I have a patient that I've been seeing here in Georgia and they are moving to Alabama to go to the lovely University of Alabama, which is the best school ever. So they are going to move to Alabama to go to school. I am able to continue practice with them through PSYPACT without them having to try to locate another provider and start all over again we built this relationship. And I'm going off to school very hard to build another relationship so trying to make sure that doesn't happen.

I understand that a lot of times on the island some people are locating back over here I hear Nevada is a very popular state for relocation so if someone is seeing a provider in your state and they move to another state they could continue those relationships if your state was a side back- participating jurisdiction. I hope that helped explain and I did make it work.

Thank you. In members and Nancy's opening comments, and members and Nancy, either you can answer this or miss Orey can. You said something about thirty days per year. Is that the amount of days they can practice, state to state or is that what was that thirty day per year? Was trying to take notes, but you're okay. Ms. Oreg, if you could please provide, some information on member Senancy's opening comments wherein he said thirty days per year.

Okay, so the telepsychology component or the APIT, the APIT, does not have any time limit. You are able to practice telepsychology with the people in the other states unlimited. The temporary authorization where I would physically go to Alabama and see someone in person has a thirty day component. I can do thirty days in Alabama, thirty days in Tennessee, Kentucky, wherever I go, but any part of a day counts as a day. So let's say I need to see someone in person and then come back to Georgia and set up the tele component, if I go over and see one person for one hour, that's one of my thirty days. It is not meant to take the place of licensure. If I physically want to live in a state, I have to get a license in that state.

Oh, okay. Thank you very much. I appreciate that answer. I have exhausted my questions. Members, do you guys have any other questions?

Chair, I believe you had a, question about insurance

payments. Thank you for reminding me. Is it covered by insurance? Do what kind of insurance do people accept? Like, typically, here, we Kaiser is our predominant medical provider, but what kind of insurance does these practitioners take?

That is a great area for us. Because we deal more with regulation than we do the insurance practice. What I have heard from my authorization holders is that they start and conduct it very similar to a face to face. They're going to check with you, they're going to verify with your insurance provider, They're going to explain what side pact is. We can provide them letters to explain because sometimes they know what we are and sometimes they don't.

And so we do have assistance that way. We have letters that the states have issued that say they consider PSYPACT authorization to be the same as a license. It's really going to be a case by case basis with the insurance company and the provider working with them as they take on new patients. We did have a benefit in that CMS did make a notification regarding Medicare that a compact privilege or authorization is considered equivalent to a licensure as far as they are concerned. So that has helped and a lot of times we are hoping that when we provide that to the third party payers like Kaiser or someplace like that, that that helps them to understand as well what the compact is.

We also expect in my crystal ball readings that as more and more healthcare professions come on with compacts, the insurance companies are going to become more aware of what a compact is.

Okay. Thank you for that. I appreciate your answers. Member Senancy.

Thank you, chair. And just for clarification, both Senators Chang and senator Fevella were the introducers for senate bill 32. And then for the house side, representatives Garrett, Amato, Bellotti, Chan, Evelyn, Capella, Kila, Kush, Loewen, Martin, Miyake, Parikh, Poipoi, Sousa, Takanochi, and Matsumoto were introducers on the house side.

Well, that's a lot of representatives. Today is representative Miyake's birthday as we were discussing all of the August babies. Yes.

A lot of August birthdays. Yes. Yeah. Thank you, chair.

Yeah. Members, any other questions? If not, we will move on to the recommendation. I would like to entertain a motion to recommend the adoption of resolution 20 five-one 138, including any non substantive revisions.

So move.

Have a motion made by member Senensi and a second by member Sugimura. Any further discussion? Member Palton, please go ahead.

Thank you. This is the twenty five dash one five three. Correct? Yes. So, my discussion would just be that when it comes to the each sac, it would be beneficial if members in NCNA's resource were there to introduce it.

I could, but I don't know that I would do the justice in introducing and answering questions. And then if it does get accepted as part of the h sack package, it would come back to us with the package to re ratify. And then we may be Najee is our executive director, but she's not always available to provide testimony when it comes up for the state hearings, and neither am I. So it would be helpful to have either the introducer or somebody else that really cares about it available at those times, which sometimes they give us so little bit notice when it comes up. It's hard to be available at all the times.

So that's just my, caveat discussion.

Thank you, member Palton. Member Sanancy, hopefully, you'll be available to advocate for your bill. Sounds like a good one. Thank you, member Palten. Any other discussion? Seeing none. All those in favor, please raise your hand and say aye. Aye. Aye. Chair, that's eight ayes, zero nos, one excused. Member Rams Fernandez, motion carries. Thank you. Moving on, we have before us resolution 25 dash one five four entitled approving for the inclusion of the 2026 Maui County Council legislative package, a state bill relating to the psychology inter jurisdictional compact. As I mentioned before, this is the same thing, just the Maui version, just our version. Member Senansi, did you wanna provide us another opening statement with any Maui specific information?

Yes, please.

Go ahead.

Thank you, chair. And we're in we have the Yohiro report that I wanted to just state some facts. And this is from the report from crisis to recovery, Health and Resilience two years after the Maui wildfires dated 06/18/2025. In it, it speaks, as far concerning adults, depressive symptoms remain widespread in the community. Half of Maui West participants, screen positive for some level of depression, with nine point five percent meeting the threshold for severe symptoms.

These figures represent a substantial increase over pre fire benchmarks. Also in the UHERO's Maui sample, twenty eight point three percent had depressive symptoms and just five point eight percent were in the severe range. Among Maui West participants, twenty six percent experienced moderate to severe anxiety with nearly twelve percent in the severe category. And this is more than 10 times higher than the pre fire Yohiro Maui report. The severe anxiety rate of one point six percent and well above the two point one percent statewide.

These elevated anxiety levels still present up to eighteen months after the disaster and they point to the need for sustained support and trauma informed mental health care. Self esteem, a critical buffer against chronic stress and mental illness, has also declined post disaster. In the Maui West cohort, twenty one point five percent of participants report low self esteem, significantly higher than pre fire levels of fifteen percent in Maui and thirteen percent statewide. Chair rates of suicidal thoughts have more than quadrupled since before the fires. In the past month, four point two percent of Maui West adults reported seriously considering suicide.

This is a sharp increase from the Uhiro Maui baseline of zero point eight percent and a statewide rate of one point two percent. Members, these findings call for continued investments in suicide prevention strategies, peer support networks and culturally responsive crisis services, accessible across the island. For youth, nearly two years after the fire, Smaui's youth are still carrying a heavy emotional burden. Across the full child cohort, twenty two percent of children report severe depressive symptoms and another twenty eight percent shows mild to moderate levels, with forty nine percent show no or minimal symptoms. And, real quick, PTSD remains widespread among children with fifty four point eight percent overall reporting little or no symptoms.

And I can share this in testimony as well. Around thirty percent show mild PTSD symptoms, while ten point eight meet critical thresholds for PTSD and four point three percent for severe PTSD. And finally, nearly thirty percent of children screen positive for probable anxiety disorder. Rates are especially high among Asian children at thirty seven percent, Filipino children thirty six point nine percent and Hispanic Latino youth thirty three point three percent. For native Hawaiian Pacific Islander children, they report the lowest anxiety burden twenty four percent, although this still represents nearly one in four youth chair.

And that concludes my report. Thank you.

Thank you, Member Senensi, for those opening comments and unfortunately those very sad statistics. I understand we have testifier, so I'm gonna read some of our testifier language. Please ensure your name appears in Microsoft Teams as the name you prefer to be referred as or as anonymous if you wish to testify anonymously. If you are in person, please notify the staff that you would like to testify anonymously. Otherwise, please state your name for the record at the beginning of your testimony.

Oral testimony is limited to three minutes per item. If you're still testifying beyond that time, I will kindly ask you to complete your testimony. Once you're done testifying or you do not wish to testify, you can also view the meeting on O'Kaku, channel fifty three Facebook live, or mauicounty.us backslash agendas. We will do our best to take up each person in an orderly fashion. We will now call on testifiers wishing to testify at this point in the meeting. So, staff, if you could please call our testifier.

Chair, there is one individual signed up to testify, and that is the royal house of Hawaii.

Aloha. This is a, this is anonymous member of the royal house of Hawaii and of a descendant of none one of the descendants of Hewa Hewa, royal patent 7447, and Heluz three two three seven. And I just wanted to ask, where are there is there any resources or, available services for the, Kanakas, the other, kupuna, the adults, and Kei Kamali'i that were enduring, like, that are still till this day going through the going through the traumas and generational traumas and historic trauma traumas of the overthrow and before the overthrow for over one hundred years. And if there are services for them to help them with all the generational and historical traumas that are accumulative and injurious continuing till we as we speak right now and for them to go back to their that they own forever which are titled royal patented lands. Because, like, we were always told for all so long, like, we were the most, like, worst people in the world or, like, we're so gross and, like, have and all of this, but we were the most holiest people on this Earth.

Doing the three main things that were, the main, goal or, like, the main aspects of life to take care of yourself, your Ohana, take care of the land, and to love God above all things. And, that would honestly help everybody. You know what I mean? Every person, every single person to to participate in taking care of the earth so the earth can take care of us. And, for them to go back to the royal paternal or real titled lands from the kingdom because those are the clear title and, those are the only cleared titles and real titles and real properties, the royal pats and RP. But, thank you for hearing me out. Thank

you very much for your testimony. Members, any clarifying questions? Seeing none. Thank you very much. Staff, do we have anybody else signed up to testify? Sure. That is

currently the only person who has signed up to testify. Would you like me to do a final call? Please. If anybody would like to testify in the chamber, please let staff know. Teams. Please raise your hand. This is final call. Three, two, one. Chair, it appears that nobody wishes to testify.

Thank you. Members saying there are no individuals wishing to testify on this item, which is Resolution 20 five-one 154. Without objection, I would now close oral testimony for this item. Objection. Thank you. As a reminder, written, testimony will continue to be accepted, and we were now gonna begin discussion. So members, do you have any questions? I guess then I'll ask Ms. Oreck if there are, counselors or therapists that specialize in indigenous generational trauma as the testifier requested.

That is, know, when I was talking earlier about our directory where you can add in the areas that you specialize in, that is something that can be added to that directory. Therefore, the consumers of services can search for that area as well as the languages.

Thank you. I appreciate your answer. Members, do we have any other questions for miss Orig or member Senensi? Member Senensi, do you have anything you would like to add before I move on to the recommendation?

No. Just that, you know, at this point, as we recover in both Upcountry and West Maui, just to make sure that our our people, that are still dealing with the tragic events two years ago, that they get the resources that they need. So if they can't find it here, hopefully, you know, Saipek can provide at least some of some to fill those gaps.

Absolutely. Thank you very much. At this time, I would like to entertain a motion to rec oh, member Palton, please go ahead. Sorry. I didn't see you.

No worries. I I guess would say I'm I'm sorry. I was on a other call while while you were discussing, but got the best news. One of the, one of my 80 year old widow fire survivors is gonna get housing shortly, and that's really the best mental health for a lot of people is to be able to have long term housing. Yay. Yay, miss Wilson.

Yay, miss Wilson. We're stoked for her. Thank you for sharing the good news, member Palatin. At this time then, I would like to entertain a motion to recommend the adoption of resolution 25 dash one five four, including any non substantive revisions.

Second.

I have a motion by member Sugimura. I have a second by member Senensi. Any further discussion? Seeing none, all those in favor, please raise your hand and say aye. Aye. Chair, that's seven ayes, zero nos to excuse member Rollins Fernandez and Chair Lee. Motion carries. Thank you. Members, these items will move on to full council At this time, it is 02:05, and this concludes the government relations, ethics, and transparency committee meeting. Thank you very much. Members, this meeting is adjourned.