Hawaii 2025 Regular Session

Hawaii Senate Bill SB727 Compare Versions

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1	1	THE SENATE S.B. NO. 727 THIRTY-THIRD LEGISLATURE, 2025 STATE OF HAWAII A BILL FOR AN ACT RELATING TO HEALTH. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	THE SENATE S.B. NO. 727
4	4	THIRTY-THIRD LEGISLATURE, 2025
5	5	STATE OF HAWAII
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7	7	THE SENATE
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9	9	S.B. NO.
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11	11	727
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13	13	THIRTY-THIRD LEGISLATURE, 2025
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	RELATING TO HEALTH.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that increasing the concentration of fluoride, a naturally occurring mineral, in a public water supply to an optimal level promotes good oral health and is an extremely effective means of stopping, preventing, or even reversing tooth decay. The practice of community water fluoridation benefits all people who drink from the public water supply of a community. The legislature recognizes that according to the United States Centers for Disease Control and Prevention (CDC), the nation's premier public health agency, water fluoridation is both safe and the most costeffective way of preventing tooth decay in a community. The success of water fluoridation in decreasing the rates of tooth decay has led the CDC to name community water fluoridation as one of ten greatest public health achievements of the twentieth century. Since 1945, hundreds of cities have implemented community water fluoridation. As of 2022, more than 209 million people, or nearly three out of every four Americans who used public water supplies, drank water with enough fluoride to prevent tooth decay. Drinking fluoridated water keeps teeth strong and reduces tooth decay by approximately twenty-five per cent in both children and adults. The value of water fluoridation has been recognized internationally and is used in many countries, including Australia, Canada, Chile, Colombia, Ireland, Malaysia, New Zealand, Singapore, and the United Kingdom. The legislature further finds that the State's public water systems have no added fluoride, except on military bases. Consequently, only nine per cent of individuals in the State have access to the benefits of fluoridated drinking water, the lowest percentage among all states in the nation, which has a corresponding national average of seventy-two per cent. According to "Hawaii Smiles 2015: The Oral Health of Hawaii's Children", the most recent comprehensive report on children's dental health from the department of health, "Hawaii's children have the highest prevalence of tooth decay in the United States". More than seven out of ten third graders in the State are affected by tooth decay, which is a substantially higher rate than the national average of fifty-two per cent. The State also received a failing grade in three oral health report cards published by the Pew Center on the States, a division of the Pew Charitable Trusts, which made the State the worst overall performer in the nation. The legislature also finds that many state residents do not have dental care insurance. According to "Hawaii Oral Health: Key Findings", another 2015 report from the department of health, the number of emergency room visits for preventable dental problems has increased. For example, in 2012, there were more than three thousand visits to emergency rooms in the State for preventable dental problems. This represented an increase of sixty-seven per cent from 2006. For comparison, according to the same report, emergency room visits for preventable dental problems increased nationwide by twenty-two per cent from 2006 to 2009. The legislature concludes that the benefits of fluoridation outweigh the risks. Notably, the State's drinking water already has additional chlorine, which is chemically similar to fluoride, in its water supply for the purpose of reducing exposure to water borne illnesses. Notwithstanding the benefits of fluoridation, residents who have dental care insurance will have better opportunities to take preventative measures for their own and their children's dental care. Accordingly, the purpose of this Act is to ensure good dental health of the residents of the State by: (l) Requiring each supplier of water in the State to adjust the level of fluoride in its public water system in conformance with a standard published by the board of water supply of each county pursuant to the most recent standard for the optimal fluoride level for community water fluoridation established by the United States Department of Health and Human Services until the governor issues a proclamation declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental services; (2) Requiring the department of health to provide each supplier of water with technical assistance and training relating to community water fluoridation and the management of fluoridation systems and submit annual status reports to the legislature; (3) Allowing the department of health to reimburse each supplier of water for necessary expenses incurred to comply with the required fluoride adjustment; and (4) Requiring the department of health to monitor the status of state residents' dental insurance coverage, submit annual status reports to the legislature, and upon confirmation that all residents of the State have either obtained or affirmatively rejected dental insurance coverage submit a written verification to the governor, who shall immediately issue a proclamation declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental care services. SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding two new sections to be appropriately designated and to read as follows: "§321-A Fluoridation of public water systems; county standard; technical assistance; training; reimbursement; annual status report. (a) Notwithstanding any other law to the contrary, each supplier of water in the State shall adjust the level of fluoride in its public water system in conformance with the standard published by the board of water supply of each county pursuant to subsection (b). (b) The board of water supply of each county shall establish and publish a standard for the level of fluoride applicable to public water systems in its jurisdiction pursuant to the most recent standard for the optimal fluoride level for community water fluoridation established by the United States Department of Health and Human Services. (c) The department of health: (1) Shall provide each supplier of water with technical assistance and training relating to community water fluoridation and the management of fluoridation systems; and (2) May reimburse each supplier of water for necessary expenses incurred to comply with this section. (d) The department of health, with the cooperation of the board of water supply of each county and all other suppliers of water in the State, shall submit a report to the legislature regarding each public water system's status of compliance with this section no later than forty days prior to the convening of each regular session. (e) Upon the issuance of a proclamation by the governor declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental care services pursuant to section 321-B(c), this section shall no longer apply to suppliers of water in the State. This section, while applicable, shall supersede any regulation, ordinance, or rule to the contrary adopted by the State, a county, or any department thereof. (f) For the purposes of this section: "Public water system" means a system that provides water for human consumption through pipes or other constructed conveyances and has at least one thousand service connections. "Person" means any individual, partnership, firm, association, joint venture, public or private corporation, trust, estate, commission, board, public or private institution, utility, cooperative, municipality, or any other private or public legal entity. "Person" does not include the United States or its wholly owned agencies or instrumentalities. "Supplier of water" means any person who owns or operates a public water system. §321-B Dental care insurance; coverage; annual status report; written verification; proclamation. (a) Notwithstanding any other law to the contrary, the department of health shall monitor on an annual basis the number of residents in the State who: (1) Have insurance coverage for dental care services; and (2) Do not have insurance coverage for dental care services, and obtain from residents who do not have insurance coverage for dental care services the reason therefor, including affirmative rejection of coverage by the resident. (b) The department of health shall submit a report to the legislature regarding the status of dental care insurance coverage for residents of the State no later than forty days prior to the convening of each regular session. (c) Upon confirmation that all residents of the State have either obtained or affirmatively rejected dental insurance coverage, the department of health shall submit a written verification to the governor, who shall immediately issue a proclamation declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental care services. The governor shall also immediately deliver a certified copy of the proclamation to the revisor of statutes." SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 for the department of health to: (1) Provide suppliers of water with technical assistance and training relating to community water fluoridation and the management of fluoridation systems; and (2) Reimburse suppliers of water for necessary expenses incurred to comply with this Act. The sums appropriated shall be expended by the department of health for the purposes of this Act. SECTION 4. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act. SECTION 5. New statutory material is underscored. SECTION 6. This Act shall take effect on July 1, 2025. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that increasing the concentration of fluoride, a naturally occurring mineral, in a public water supply to an optimal level promotes good oral health and is an extremely effective means of stopping, preventing, or even reversing tooth decay. The practice of community water fluoridation benefits all people who drink from the public water supply of a community.
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51	51	The legislature recognizes that according to the United States Centers for Disease Control and Prevention (CDC), the nation's premier public health agency, water fluoridation is both safe and the most costeffective way of preventing tooth decay in a community. The success of water fluoridation in decreasing the rates of tooth decay has led the CDC to name community water fluoridation as one of ten greatest public health achievements of the twentieth century. Since 1945, hundreds of cities have implemented community water fluoridation. As of 2022, more than 209 million people, or nearly three out of every four Americans who used public water supplies, drank water with enough fluoride to prevent tooth decay. Drinking fluoridated water keeps teeth strong and reduces tooth decay by approximately twenty-five per cent in both children and adults. The value of water fluoridation has been recognized internationally and is used in many countries, including Australia, Canada, Chile, Colombia, Ireland, Malaysia, New Zealand, Singapore, and the United Kingdom.
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53	53	The legislature further finds that the State's public water systems have no added fluoride, except on military bases. Consequently, only nine per cent of individuals in the State have access to the benefits of fluoridated drinking water, the lowest percentage among all states in the nation, which has a corresponding national average of seventy-two per cent. According to "Hawaii Smiles 2015: The Oral Health of Hawaii's Children", the most recent comprehensive report on children's dental health from the department of health, "Hawaii's children have the highest prevalence of tooth decay in the United States". More than seven out of ten third graders in the State are affected by tooth decay, which is a substantially higher rate than the national average of fifty-two per cent. The State also received a failing grade in three oral health report cards published by the Pew Center on the States, a division of the Pew Charitable Trusts, which made the State the worst overall performer in the nation.
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55	55	The legislature also finds that many state residents do not have dental care insurance. According to "Hawaii Oral Health: Key Findings", another 2015 report from the department of health, the number of emergency room visits for preventable dental problems has increased. For example, in 2012, there were more than three thousand visits to emergency rooms in the State for preventable dental problems. This represented an increase of sixty-seven per cent from 2006. For comparison, according to the same report, emergency room visits for preventable dental problems increased nationwide by twenty-two per cent from 2006 to 2009.
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57	57	The legislature concludes that the benefits of fluoridation outweigh the risks. Notably, the State's drinking water already has additional chlorine, which is chemically similar to fluoride, in its water supply for the purpose of reducing exposure to water borne illnesses. Notwithstanding the benefits of fluoridation, residents who have dental care insurance will have better opportunities to take preventative measures for their own and their children's dental care.
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59	59	Accordingly, the purpose of this Act is to ensure good dental health of the residents of the State by:
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61	61	(l) Requiring each supplier of water in the State to adjust the level of fluoride in its public water system in conformance with a standard published by the board of water supply of each county pursuant to the most recent standard for the optimal fluoride level for community water fluoridation established by the United States Department of Health and Human Services until the governor issues a proclamation declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental services;
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63	63	(2) Requiring the department of health to provide each supplier of water with technical assistance and training relating to community water fluoridation and the management of fluoridation systems and submit annual status reports to the legislature;
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65	65	(3) Allowing the department of health to reimburse each supplier of water for necessary expenses incurred to comply with the required fluoride adjustment; and
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67	67	(4) Requiring the department of health to monitor the status of state residents' dental insurance coverage, submit annual status reports to the legislature, and upon confirmation that all residents of the State have either obtained or affirmatively rejected dental insurance coverage submit a written verification to the governor, who shall immediately issue a proclamation declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental care services.
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69	69	SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding two new sections to be appropriately designated and to read as follows:
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71	71	"§321-A Fluoridation of public water systems; county standard; technical assistance; training; reimbursement; annual status report. (a) Notwithstanding any other law to the contrary, each supplier of water in the State shall adjust the level of fluoride in its public water system in conformance with the standard published by the board of water supply of each county pursuant to subsection (b).
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73	73	(b) The board of water supply of each county shall establish and publish a standard for the level of fluoride applicable to public water systems in its jurisdiction pursuant to the most recent standard for the optimal fluoride level for community water fluoridation established by the United States Department of Health and Human Services.
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75	75	(c) The department of health:
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77	77	(1) Shall provide each supplier of water with technical assistance and training relating to community water fluoridation and the management of fluoridation systems; and
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79	79	(2) May reimburse each supplier of water for necessary expenses incurred to comply with this section.
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81	81	(d) The department of health, with the cooperation of the board of water supply of each county and all other suppliers of water in the State, shall submit a report to the legislature regarding each public water system's status of compliance with this section no later than forty days prior to the convening of each regular session.
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83	83	(e) Upon the issuance of a proclamation by the governor declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental care services pursuant to section 321-B(c), this section shall no longer apply to suppliers of water in the State. This section, while applicable, shall supersede any regulation, ordinance, or rule to the contrary adopted by the State, a county, or any department thereof.
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85	85	(f) For the purposes of this section:
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87	87	"Public water system" means a system that provides water for human consumption through pipes or other constructed conveyances and has at least one thousand service connections.
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89	89	"Person" means any individual, partnership, firm, association, joint venture, public or private corporation, trust, estate, commission, board, public or private institution, utility, cooperative, municipality, or any other private or public legal entity. "Person" does not include the United States or its wholly owned agencies or instrumentalities.
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91	91	"Supplier of water" means any person who owns or operates a public water system.
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93	93	§321-B Dental care insurance; coverage; annual status report; written verification; proclamation. (a) Notwithstanding any other law to the contrary, the department of health shall monitor on an annual basis the number of residents in the State who:
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95	95	(1) Have insurance coverage for dental care services; and
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97	97	(2) Do not have insurance coverage for dental care services,
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99	99	and obtain from residents who do not have insurance coverage for dental care services the reason therefor, including affirmative rejection of coverage by the resident.
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101	101	(b) The department of health shall submit a report to the legislature regarding the status of dental care insurance coverage for residents of the State no later than forty days prior to the convening of each regular session.
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103	103	(c) Upon confirmation that all residents of the State have either obtained or affirmatively rejected dental insurance coverage, the department of health shall submit a written verification to the governor, who shall immediately issue a proclamation declaring the date on which all residents of the State have either obtained or affirmatively rejected insurance coverage for dental care services. The governor shall also immediately deliver a certified copy of the proclamation to the revisor of statutes."
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105	105	SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 for the department of health to:
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107	107	(1) Provide suppliers of water with technical assistance and training relating to community water fluoridation and the management of fluoridation systems; and
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109	109	(2) Reimburse suppliers of water for necessary expenses incurred to comply with this Act.
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111	111	The sums appropriated shall be expended by the department of health for the purposes of this Act.
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113	113	SECTION 4. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.
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115	115	SECTION 5. New statutory material is underscored.
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119	119	SECTION 6. This Act shall take effect on July 1, 2025.
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123	123	INTRODUCED BY: _____________________________
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125	125	INTRODUCED BY:
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133	133	Report Title: DOH; Counties, Water Fluoridation; Water Suppliers; Public Water Systems; Training; Dental Care Insurance; Coverage; Proclamation; Reports; Appropriations Description: Requires suppliers of water in the State to adjust the level of fluoride in its public water system in conformance with a standard published by the Board of Water Supply of each county until the issuance of a proclamation by the Governor declaring the date on which all residents of the State have either obtained or affirmatively rejected dental insurance coverage and provide a certified copy to the Revisor of Statutes. Requires the Department of Health to provide suppliers of water with technical assistance and training and submit annual status reports to the Legislature regarding the public water systems' status of compliance with the fluoride adjustment requirement. Allows the Department of Health to reimburse suppliers of water for necessary expenses incurred for compliance. Requires the Department of Health to monitor dental insurance coverage of the State's residents, submit annual status reports to the Legislature, and upon confirmation that all residents of the State have either obtained or affirmatively rejected dental insurance coverage, submit a written verification to the Governor. Requires the Governor to issue a proclamation. Appropriates funds. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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141	141	Report Title:
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143	143	DOH; Counties, Water Fluoridation; Water Suppliers; Public Water Systems; Training; Dental Care Insurance; Coverage; Proclamation; Reports; Appropriations
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147	147	Description:
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149	149	Requires suppliers of water in the State to adjust the level of fluoride in its public water system in conformance with a standard published by the Board of Water Supply of each county until the issuance of a proclamation by the Governor declaring the date on which all residents of the State have either obtained or affirmatively rejected dental insurance coverage and provide a certified copy to the Revisor of Statutes. Requires the Department of Health to provide suppliers of water with technical assistance and training and submit annual status reports to the Legislature regarding the public water systems' status of compliance with the fluoride adjustment requirement. Allows the Department of Health to reimburse suppliers of water for necessary expenses incurred for compliance. Requires the Department of Health to monitor dental insurance coverage of the State's residents, submit annual status reports to the Legislature, and upon confirmation that all residents of the State have either obtained or affirmatively rejected dental insurance coverage, submit a written verification to the Governor. Requires the Governor to issue a proclamation. Appropriates funds.
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157	157	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.