REPORT TITLE:
QUEST


DESCRIPTION:
Requires DHS to compensate community health centers treating
QUEST patients based on risk factor adjustment.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                            1413        
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO QUEST. 


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 assure that funds appropriated for
 
 3 Medicaid managed care services under QUEST are distributed
 
 4 equitably to health plans under contract with QUEST.  The
 
 5 legislature further finds that the capitation methodology used by
 
 6 QUEST to compensate providers is outdated, being based on a fee-
 
 7 for-service model that presumes a healthy population being served
 
 8 by QUEST.  In fact, QUEST has a disproportionate share of
 
 9 medically high risk patients who need more than average medical
 
10 attention, known as "adverse selection".  Undercompensated QUEST
 
11 providers tend to be community health centers that serve patients
 
12 in greatest need of medical care. 
 
13      The legislature further finds that community health centers
 
14 are in need of adequate compensation from QUEST in order to
 
15 survive.  Adequate compensation can be achieved through a change
 
16 to a risk factor adjustment system.
 
17      The purpose of this Act is to establish a risk factor
 
18 adjustment system to compensate QUEST providers.
 
19      SECTION 2.  Chapter 346, Hawaii Revised Statutes, is amended
 

 
Page 2                                         1413        
                                     H.B. NO.           
                                                        
                                                        

 
 1 by adding a new section to be appropriately designated and to
 
 2 read as follows:
 
 3      "346-    Payment methodology for QUEST.  (a)  The
 
 4 department shall compensate community health centers providing
 
 5 services to QUEST patients based upon risk factor adjustment for
 
 6 serious medical conditions.
 
 7      (b)  As used in subsection (a), "risk factor adjustment"
 
 8 means a method of compensation that accounts for patient health
 
 9 risk characteristics of the QUEST patients being served by a
 
10 particular community health center, for example, chronic
 
11 diseases, HIV patients, or pregnant teenagers."
 
12      SECTION 3.  The department of human services shall adjust
 
13 its current payment to community health centers based upon this
 
14 Act.
 
15      SECTION 4.  New statutory material is underscored.
 
16      SECTION 5.  This Act shall take effect upon its approval.
 
17 
 
18                           INTRODUCED BY:  _______________________