REPORT TITLE:
Federally Qualified Health Centers


DESCRIPTION:
Requires that payments by department of human services to
federally qualified health centers be no less than payments to
other providers providing QUEST services.  Appropriates funds for
fiscal year 2000-2001 with federal matching funds.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2238
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO FEDERALLY QUALIFIED HEALTH CENTERS.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The legislature finds that it is in the best
 
 2 interest of the State to ensure access to primary and preventive
 
 3 health care to all residents.  One of the State's best strategies
 
 4 to meet this important goal is to support a system of nonprofit
 
 5 community health centers that meet the criteria for federally
 
 6 qualified health centers or rural health centers in areas with
 
 7 high socio-economic needs and few health care providers.
 
 8      These federally qualified health centers and rural health
 
 9 centers are cost-effective, community-based nonprofit
 
10 organizations, and are accessible to all regardless of financial,
 
11 language, or other barriers.  These health centers provide
 
12 comprehensive primary and preventive health care and a broad
 
13 range of services that are crucial to overcoming nonfinancial
 
14 barriers to care, such as language assistance, culturally
 
15 competent care, transportation, follow-up, referral, and health
 
16 education.  They also reach out to those in their communities who
 
17 avoid or distrust the medical system.  Federally qualified health
 
18 centers and rural health centers provide a wide range of services
 

 
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 1 that are crucial for the many low-income, native Hawaiian,
 
 2 immigrant, homeless, and uninsured families and individuals of
 
 3 the State.
 
 4      The legislature further finds that federally qualified
 
 5 health centers and rural health centers contribute greatly to the
 
 6 economy of the depressed areas they serve, being directly or
 
 7 indirectly responsible for adding $73,000,000 and nine hundred
 
 8 jobs to the local economy.  The legislature further finds that
 
 9 one of the best ways to ensure the financial viability of
 
10 federally qualified health centers and rural health centers is
 
11 through adequate Medicaid/QUEST reimbursement.  Using this
 
12 financing mechanism, scarce state funds are matched by federal
 
13 funds to maximize available resources.
 
14      The purpose of this Act is to provide a mechanism to provide
 
15 supplemental Medicaid/QUEST payment to federally qualified health
 
16 centers and rural health centers with federally-matched funds
 
17 that parallels the provisions of the federal Balanced Budget Act
 
18 of 1997 (P.L. 105-33).
 
19      SECTION 2.  Chapter 346, Hawaii Revised Statutes, is amended
 
20 by adding a new section to be appropriately designated and to
 
21 read as follows:
 

 
 
 
 
 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      "§346-     Hawaii QUEST contracts with federally qualified
 
 2 health centers; payments.  (a)  Whenever the department of human
 
 3 services contracts with a managed care organization for the
 
 4 provision of QUEST services to enrollees, the contract shall
 
 5 provide that in the case of services furnished to the managed
 
 6 care organization's enrollees by a federally qualified health
 
 7 center or rural health center pursuant to a contract between the
 
 8 managed care organization and the federally qualified health
 
 9 center or rural health center, payment to the federally qualified
 
10 health center or rural health center by the managed care
 
11 organization shall be comparable to, but no less than, the amount
 
12 the managed care organization pays to its other providers in the
 
13 same geographic area for comparable services.
 
14      (b)  At least quarterly, the department of human services
 
15 shall pay to the federally qualified health centers or rural
 
16 health centers the difference between the payment received by the
 
17 federally qualified health center or rural health center from the
 
18 managed care organization and the reasonable cost of the
 
19 federally qualified health center or rural health center in
 
20 providing services to the managed care organization's QUEST
 
21 enrollees, which reasonable cost shall be determined pursuant to
 
22 section 1902(a)(13)(C)(i) of the Social Security Act (as amended
 
23 by the Balanced Budget Act of 1997), and any applicable
 

 
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 1 regulations adopted thereunder.  In carrying out the payment
 
 2 requirements of this section, the department shall not delegate
 
 3 responsibility for the payments to the managed care organization
 
 4 or any other entity, but shall be responsible for making the
 
 5 payments directly to the federally qualified health center or
 
 6 rural health center.
 
 7      (c)  In accordance with the Balanced Budget Act of 1997
 
 8 (P.L. 105-33), cost-based reimbursement for federally qualified
 
 9 health centers and rural health centers shall be phased out as
 
10 follows:
 
11              Year                     Cost-Based Reimbursement
 
12 October 1, 1997 - September 30, 2001          100 per cent
 
13 October 1, 1999 - September 30, 2002           95 per cent
 
14 October 1, 2000 - September 30, 2003           90 per cent
 
15 October 1, 2001 - September 30, 2004           85 per cent
 
16 October 1, 2002 - September 30, 2005           70 per cent"
 
17      SECTION 3.  There is appropriated out of the general
 
18 revenues of the State of Hawaii the sum of $          or so much
 
19 thereof as may be necessary for fiscal year 2000-2001 for the
 
20 purposes of this Act; provided that no funds shall be made
 
21 available unless matched by federal funds to the maximum allowed
 
22 under the Medicaid program.
 
23      The sum appropriated shall be expended by the department of
 
24 human services for the purposes of this Act.
 

 
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 1      SECTION 4.  New statutory material is underscored.
 
 2      SECTION 5.  This Act shall take effect on July 1, 2000.
 
 3 
 
 4                              INTRODUCED BY:______________________