Report Title:
QUEST
Description:
Removes financial disincentives for health plans and providers to allow them to provide enabling services. Allows the Department of Human Services more flexibility in determining eligibility for Med-QUEST coverage. (HB1234 CD1)
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1234 |
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TWENTY-FIRST LEGISLATURE, 2001 |
H.D. 1 |
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STATE OF HAWAII |
S.D. 2 |
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C.D. 1 |
RELATING TO QUEST.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
SECTION 1. The legislature finds that it is in the best interest of the State to ensure access to primary and preventive health care for its residents. In addition to creating a healthier population, access to health care reduces state expenditures arising from hospital and emergency room services for preventable injuries or illnesses.
The legislature further finds that Hawaii's system of nonprofit, community health care providers actively outreach to many high-risk/high-cost patients who otherwise would not seek out primary medical care.
The services delivered by health centers to ensure access to otherwise noncompliant patients are called enabling services.
The purpose of this Act is to remove financial disincentives for health plans and providers to actively reach out to high-risk populations, including high-risk pregnant women and girls, native Hawaiians with early onset of chronic diseases, and chronic substance abusers.
SECTION 2. The provisions of the Sixth Omnibus Budget Reconciliation Act (SOBRA) for risk adjusting for deliveries, shall be incorporated into fiscal year 2002 QUEST bid process unless the following occurs:
(1) QUEST health plans encounter data that show no QUEST health plans had more than ten per cent of births per one thousand female members compared to the QUEST average deliveries per one thousand female members in all of the three QUEST contract years beginning 1998, 1999, and 2000; and
(2) The department of human services provides a report to the legislature no later than twenty days prior to the convening of the regular session of 2002 to include:
(A) The risk adjustment methodology to be used in the QUEST bid process beginning July 1, 2002; and
(B) Incorporation of adequate risk adjustments to account for any disparity in births that may occur in QUEST health plans.
SECTION 3. The department of human services shall define enabling services to be provided by QUEST plans to include all of the following:
(1) All federally qualified health center enabling services covered by medicaid payments prior to initiation of the QUEST program, including those covered under early periodic screening development testing; and
(2) Case management, outreach, and supportive counseling provided by community health workers and other health professionals at federally qualified health centers for patients with multiple diagnoses as noted in patient medical records.
PART II
SECTION 4. The legislature finds that the federal children's health insurance program provides Hawaii with an important opportunity to expand health care coverage to low-income children who are uninsured. The children's health insurance program is considered the largest expansion of health care coverage since the enactment of medicare and medicaid.
Children and most adolescents are usually dependent on parents and caregivers for access to health care to maintain good health. When they become sick or are injured, most children and adolescents have access to a health care professional or service. However, too many children and adolescents in the United States, particularly those from poor families or in rural or isolated communities, are at risk for multiple health problems because they lack health insurance or access to a primary care provider. Indigent children may experience two to three times the usual incidence of certain medical conditions, many of which are preventable. Even those adolescents who have health insurance and a primary care provider do not readily seek medical care and their parents or caregivers find it difficult to maintain regular visits to the pediatrician or family doctor for their teenagers. The most common health problems affecting children and adolescents today include injuries, chronic illnesses such as asthma, and mental health problems. In addition, adolescents and pre-adolescents are now engaging frequently in risky behavior that may lead to health problems, including smoking, alcohol, illegal drugs, and unsafe sex.
The legislature finds that the concept of universal access will facilitate preventive health practices. However, the legislature understands that developing a comprehensive and integrated approach to improve children's health requires more outreach, education, and awareness of good public and personal health practices.
Collaboration, communication, and cooperation among schools, parents, students, community agencies, and organizations are essential to establishing a successful school and community health system that addresses the health needs of all children. Over time, this will ensure a seamless system of prevention, early intervention, and when necessary, care of every child.
The purpose of this part to allow children whose family income is at or below two hundred per cent, and up to three hundred per cent depending on resources available, of the federal poverty level to be eligible for health insurance under the State's Med-QUEST program.
SECTION 5. The department of human services shall be allowed the flexibility to allow children whose family income is at or below two hundred per cent, and up to three hundred per cent depending on the resources available, of the federal poverty level to be eligible for health insurance under the State's Med-QUEST program.
SECTION 6. This Act shall take effect upon its approval.