HB2712

HOUSE OF REPRESENTATIVES	H.B. NO.	2712
THIRTY-SECOND LEGISLATURE, 2024
STATE OF HAWAII

A BILL FOR AN ACT

relating to autism.

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

SECTION 1. The legislature finds that applied behavioral analysis is a medically necessary service for young people with autism, which can decrease the cost of care for persons with autism over their lifetimes. The department of human services' med-QUEST division covers applied behavioral analysis services for persons with autism up to twenty-one years of age. However, med-QUEST patients are sometimes unable to access recommended services due to the unavailability of providers.

The legislature further finds that med-QUEST reimbursement rates for applied behavioral analysis have not increased since 2015. Since that time, the Hawaii labor market has experienced significant wage pressure and med-QUEST beneficiaries must compete for applied behavioral analysis services with the private sector and other government programs, such as the department of education and department of health, which offer significantly higher reimbursement rates.

At the request of the legislature, a report was submitted in December 2023 based on a study commissioned by the med-QUEST division and conducted by actuarial firm Milliman. Reimbursement rates and costs were researched for a broad range of applied behavioral analysis services. Three rate scenarios were modeled in the study, all of which exceeded existing rates. The lowest rate is based on the fiftieth percentile Bureau of Labor Statistics wage blend for direct care staff, while the highest rate is based on the seventy-fifth percentile of the same data. The medium rate is based on the median direct care staff wage from a survey of applied behavioral analysis service providers.

Furthermore, the legislature finds that modeled rates for individual one-to-one services increased significantly for all scenarios. However, modeled rates for group services decreased for the lowest and medium rate scenarios. Part of the decrease stems from the fact that indirect time has become separately billable since the med-QUEST division rates were set and is thus not included in the rate. Another reason is that group rates were decreased to reflect the number of members served simultaneously, rather than allowing the same rate to be charged concurrently for each client, which is the med-QUEST division's existing guideline.

The legislature also finds that the lowest-rate scenario requires a composite rate change of 33.9 per cent and will require $2,690,000 in state funds, which will be matched by a corresponding $3,810,000 increase in federal funds. Moreover, the legislature finds that the concomitant increase in federal matching funds will result in a greater impact on the reimbursement rates received by applied behavioral analysis service providers.

Therefore, the purpose of this Act is to appropriate funds to increase funding for the department of human services' med-QUEST division reimbursement for applied behavioral analysis services.

SECTION 2. 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 2024-2025 to increase funding for applied behavioral analysis services; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure; provided further that the department of human services shall pursue all funding sources available to the State, including private grants, prior to expending any general revenues appropriated pursuant to this Act.

The sum appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 3. In accordance with section 9 of article VII of the Hawaii State Constitution and sections 37‑91 and 37‑93, Hawaii Revised Statutes, the legislature has determined that the appropriations contained in H.B. No. , will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. In addition, the appropriation contained in this Act will cause the general fund expenditure ceiling for fiscal year 2024‑2025 to be further exceeded by $ or per cent. The combined total amount of general fund appropriations contained in only these two Acts will cause the state general fund expenditure ceiling for fiscal year 2024‑2025 to be exceeded by $ or per cent. The reasons for exceeding the general fund expenditure ceiling are that:

(1) The appropriation made in this Act is necessary to serve the public interest; and

(2) The appropriation made in this Act meets the needs addressed by this Act.

SECTION 4. This Act shall take effect on July 1, 2024.

INTRODUCED BY:	_____________________________