Report Title:
Medicaid; Cost Share Program
Description:
Allows the Department of Human Services to provide for positive enrollment in a request for proposal for QUEST plans, with limitations and certain safeguards. (HB2043 CD1)
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
2043 |
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TWENTY-THIRD LEGISLATURE, 2006 |
H.D. 2 |
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STATE OF HAWAII |
S.D. 3 |
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C.D. 1 |
A BILL FOR AN ACT
RELATING TO MEDICAID.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. On March 13, 2006, the department of human services issued a request for proposals regarding the QUEST program. A provision in the request for proposals required all one hundred sixty-five thousand current QUEST beneficiaries to re-select a QUEST plan and a primary care provider. The department of human services referred to this process as "positive enrollment."
All current QUEST beneficiaries have already selected and been assigned to a QUEST health plan and have selected a primary care physician. Requiring this vulnerable population to comply with the positive enrollment requirements may cause confusion, delay in needed health care procedures, disrupt case management, or result in the loss of contact between patients and their current primary care providers. Further, positive enrollment may result in an indeterminate spectrum of adverse outcomes, including additional costs and administrative burdens on QUEST providers as well as on the department of human services.
This Act, which allows the department of human services to provide for positive enrollment for an initial enrollment period of sixty days will create a situation whereby all QUEST health plans who bid on the request for proposals, including any new plans that enter the marketplace, will be on an equal footing in terms of being able to market to all QUEST enrollees to stimulate and achieve competition as advocated by the department of human services. However, to minimize any possible disruption of service, this Act provides some limitations to the positive enrollment program. The major limitation is that, of the number of QUEST beneficiaries that do not enroll in a health plan during the initial enrollment period and will be auto-assigned to a plan, the department of human services will auto-assign not more than five per cent of the total QUEST beneficiaries. The five per cent amount was chosen because the department of human services has maintained that only five per cent of the total QUEST membership do not choose a plan. For example, if there are one hundred sixty-five thousand QUEST beneficiaries at the start of the initial enrollment period, a maximum of eight thousand two hundred fifty beneficiaries can be auto-assigned to the chosen health plan to receive these beneficiaries, and the remaining beneficiaries who do not voluntarily enroll in a plan shall remain with the plan in which they were currently enrolled. The department of human services shall devise a method to randomly pick the beneficiaries to be auto-assigned.
Further, this Act adopts the recommendations of the department of human services and requires the department of human services to provide for the following safeguards and quality control measures to address previously stated concerns of potential disruption of services by:
(1) Including in the request for proposals that each medicaid QUEST recipient will have sixty days to positively choose a health plan;
(2) Granting each medicaid QUEST recipient who may be auto-assigned, an additional ninety days to change the recipient's health plan for any reason;
(3) Ensuring that if a person is auto-assigned to a new plan and that person shows up by mistake for a visit at the person's previous plan's provider, there will be no disruption in receiving medical services, even if that provider is not in the new plan, and also ensuring that the client will receive treatment at that time, for which the department of human services will pay the provider;
(4) Ensuring that the person will also have the opportunity during a visit to a provider to immediately opt out of the auto-assigned health care plan and switch back into the previous plan or into another plan; and
(5) Ensuring that the department of human services will conduct a public awareness campaign, including the option to contract with advocacy, outreach, and other community groups to educate medicaid QUEST recipients about their new plan options and shall include a provider directory of fully contracted providers to assist beneficiaries in their decision-making.
SECTION 2. The department of human services, Med-Quest division, that is responsible for the QUEST program and the issuance of a request for proposals for health plans to submit proposals to provide required medical and behavioral health services to eligible QUEST recipients, shall include the following basic provisions in the request for proposals that:
(1) All individuals who are existing members of QUEST health plans will be required to select a health plan for the initial enrollment period that shall last for a period of sixty days; and
(2) After the conclusion of the sixty-day period, a certain number of existing members of QUEST health plans who have not selected a health plan shall be assigned by the department of human services to a health plan according to the auto-assignment algorithm described in the request for proposal.
SECTION 3. In addition to the provisions set forth in section 2, the department of human services shall also include the following provisions in the request for proposals to minimize any possible disruption that may occur to the total number of QUEST recipients who have not selected a health plan:
(1) The department of human services shall not auto-assign more than the number of recipients that is equivalent to five per cent of the total existing QUEST recipients at the start of the initial enrollment period;
(2) The department of human services shall randomly choose five per cent of the recipients to be assigned in accordance with this section; and
(3) The number of QUEST recipients who have not selected a health plan and are not auto-assigned as stated above shall remain with and be assigned back to the health plan they were enrolled in at the start of the initial enrollment period.
SECTION 4. The department of human services shall also include the following provisions in the request for proposals that are the safeguards proposed by the department of human services:
(1) A provision to grant each medicaid QUEST recipient who may be auto-assigned an additional ninety days to change the recipient's health plan for any reason;
(2) A provision to ensure that if a person is auto-assigned to a new plan and that person shows up by mistake for a visit at a previous plan's provider, there will be no disruption in receiving medical services, even if that provider is not in the new plan, and also to ensure that the client will receive treatment at that time, for which the department of human services will pay the provider;
(3) A provision to ensure that the person will also have the opportunity during a visit to a provider to immediately opt out of the auto-assigned health care plan and switch back into the previous plan or into another plan; and
(4) A provision to ensure that the department of human services will conduct a public awareness campaign to educate medicaid QUEST recipients about their new plan options, including a provider directory of fully contracted providers in each plan to assist beneficiaries in their decision-making.
SECTION 5. This Act shall take effect upon its approval.