Approp. Medically Underserved

Makes appropriations for DHS to support primary care for
medically underserved populations.  (HB1641 HD1)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that it is in the best
 2 interests of the State to ensure access to primary and preventive
 3 health care to all its residents.  This care not only results in
 4 a healthier and more productive population but also reduces
 5 publicly-supported costs for hospital and emergency room use for
 6 preventable conditions.
 7      The legislature further finds that certain individuals
 8 covered by QUEST are not receiving sufficient medical treatment
 9 and require additional clinical and other services to improve
10 their health.
11      The legislature also finds that access to primary and
12 preventive health care is in jeopardy as the number of medically
13 uninsured persons has increased by a rate of fifty per cent
14 between 1992 and 1997 from seventy thousand to one hundred five
15 thousand six hundred individuals.
16      The legislature also finds that Hawaii has a unique system
17 of nonprofit community-based providers of care who have an
18 expertise in caring for those with cultural and socioeconomic
19 barriers to care.  These nonprofit community-based providers
20 contribute greatly to the economies of the depressed areas they

Page 2                                                     1641
                                     H.B. NO.           H.D. 1

 1 serve by directly or indirectly adding $73,000,000 and nine
 2 hundred jobs to the local economy annually.
 3      The legislature further finds that adequate financial
 4 support to ensure the sustainability of this nonprofit
 5 community-based system of care has been diminished by inadequate
 6 payments for services to patients covered by Medicaid managed
 7 care (QUEST) and by insufficient state funding for purchase of
 8 service contracts for health care services for the uninsured.
 9      The legislature further finds that the State receives twice
10 as much for each dollar spent for supporting Medicaid costs for
11 services rendered by eligible, nonprofit community-based
12 providers because half of those costs are reimbursed by the
13 federal government.
14      The purpose of this Act is to maximize the availability of
15 combined state and federal resources to ensure the viability and
16 sustainability of the nonprofit community-based system of care
17 for the uninsured and persons covered by QUEST.
18      SECTION 2.  Whenever the department of human services
19 contracts with a health plan for the provision of QUEST services
20 to enrollees, that contract shall provide that in the case of
21 services furnished under contract to the health plan's enrollees
22 by a federally qualified health center or rural health center,
23 payment to the federally qualified health center or rural health

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                                     H.B. NO.           H.D. 1

 1 center by the plan shall be comparable to, but no less than, the
 2 amount that plan pays to its other providers in the same
 3 geographic area for comparable services.
 4      At least quarterly, the department of human services shall
 5 pay the federally qualified health centers or rural health
 6 centers the difference between the payment received by the
 7 federally qualified health center or rural health center from the
 8 health plans and the reasonable cost of the federally qualified
 9 health center or rural health center in providing those services
10 to the plan's QUEST enrollees.  Reasonable cost shall be
11 determined pursuant to section 1902(a)(13)(C)(i) of the federal
12 Social Security Act, and any applicable regulations promulgated
13 thereunder.
14      SECTION 3.  The department of health shall provide resources
15 to nonprofit community-based providers for caring for the
16 uninsured.  Distribution of those funds may be on a "per visit"
17 basis and shall take into consideration needs of uninsured
18 persons on all islands.  Nonprofit community-based providers that
19 are appropriate recipients of those funds and resources include
20 without limitation, community health centers, school-based
21 clinics, and the care-a-van program for the homeless.
22      SECTION 4.  There is appropriated out of the general
23 revenues of the State of Hawaii the sum of $1 or so much thereof

Page 4                                                     1641
                                     H.B. NO.           H.D. 1

 1 as may be necessary for fiscal year 1999-2000 to support health
 2 care for primary care for medically underserved populations.
 3      The sum appropriated shall be expended by the department of
 4 human services for the purposes of this Act.
 5      SECTION 5.  This Act shall take effect on July 1, 1999.