QUEST; Appropriations; Removal of Financial Disincentives
Removes financial disincentives for health plans and providers to actively out-reach high-risk populations and appropriates funds in the amount of $1 for DHS to hire additional staff for the purpose of this Act. (SD1)
TWENTY-FIRST LEGISLATURE, 2001
STATE OF HAWAII
A BILL FOR AN ACT
Relating to quest.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that it is in the best interest of the State to ensure access to primary and preventative health care for its residents. In addition to creating a healthier population, access to health care also 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 healthcare providers are actively outreaching to many high-risk and high cost patients that otherwise would not seek out primary medical care.
The purpose of the Act is to remove financial disincentives for health plans and providers to actively outreach to high-risk populations, including high risk pregnant women and girls, Native Hawaiians with early onset of chronic disease, and chronic substance abusers.
SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- QUEST; withholding of capitation payment. The department of human services shall direct the MED-QUEST program to calculate and withhold from health plan capitation payment dollars budgeted for perinatal services including obstetric and other delivery cost. All withheld funds shall be pooled and distributed by plans retrospectively on a case rate basis when there is a documented pregnancy within the health plan's population."
SECTION 3. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- QUEST; claims data. (a) The department of human services shall require the MED-QUEST program to obtain from QUEST health plans, claims data paid on substance abuse and related behavioral health encounter information.
(b) The MED-QUEST program shall use the data to assess the feasibility of a substance abuse carve out, an initiative that will focus on the services problem of methamphetamines and related drugs beginning July 1, 2002."
SECTION 4. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- QUEST; enabling services; definitions. The department of human services shall define enabling services to be provided by QUEST plans. The enabling services shall include:
(1) All federally qualified health center enabling services covered by Medicaid payments prior to initiation of the QUEST program including those covered by early periodic screening development testing. The following shall be used for the federally qualified health center enabling services definitions:
(A) "Case management" means documented client-centered service provided either on-site or off-site that links clients with health care and psychosocial services to ensure timely, coordinated access to appropriate levels of health and support services and continuity of care for improving or maintaining the individual life management skills or the ability to function in the community or both. Key activities in this area include:
(i) Assessment of the client's needs and personal support system;
(ii) Development of a written, comprehensive, individualized service plan including goal development;
(iii) Coordination of services required to implement the plan; client monitoring to assess efficacy of the plan; or
(iv) Periodic reevaluation and adaptation of the plans as necessary.
(B) "Outreach services" means locating high need, resistant to services, or hope bound individuals by developing and utilizing active and passive case-finding efforts to engage them in basic services for the purposes of improving their health, mental health, or social functioning or increasing their human service and resource utilization. Types of contact include but not limited to case finding, education, or other engagement strategies, information and referral, and follow-up. Specific examples for this type of service includes home visiting for:
(i) Missed prenatal care visits,
(ii) Newborn assessment and care training, or
(iii) Contacting patients without phones and including assistance in completing necessary QUEST administrative requirements to remain QUEST eligible.
(C) "Supportive counseling services" means counseling sessions for the purpose of providing a supportive environment to discuss a client's concerns. This counseling can be provided on an individual, group, or family basis and may include the use of traditional healers. Specific lifestyle issues, such as homelessness, substance abuse, housing and similar issues can be addressed in this forum.
(2) Native Hawaiian and traditional healing services when there is documentation in the patient's medical record, entered by their primary care physician, that such services are part of a plan to facilitate comprehensive primary care services and treatment."
SECTION 5. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- QUEST; federal review. The department of human services shall have the MED-QUEST program submit for federal review any changes in the state Medicaid plan required by this Act."
SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $1, or so much thereof as may be necessary for fiscal year 2001-2002, for the additional staffing of the department of human service to effectuate the purpose of this Act.
SECTION 7. The sum appropriated shall be expended by the department of human services for the purposes of this Act.
SECTION 8. New statutory material is underscored.
SECTION 9. This Act shall take effect on July 1, 2001.