THE SENATE

S.C.R. NO.

106

TWENTY-SECOND LEGISLATURE, 2004

S.D. 1

STATE OF HAWAII

 
   


SENATE CONCURRENT

RESOLUTION

 

REQUESTING an inquiry into the delays in PAYMENT to DEVELOPMENTAL DISABILITY PROVIDERS.

 

WHEREAS, under the State's Medicaid Waiver Program, services for individuals with developmental disorders are contracted out by the Department of Human Services to developmental disability providers; and

WHEREAS, the Department of Human Services has also contracted out the billing and reimbursement for services to a private vendor, the Affiliated Computer Services, Inc.; and

WHEREAS, the billing, coding, and reimbursement system used by the Affiliated Computer Services, Inc., has the effect of holding providers "hostage" while attempts are made to resolve systemic problems that delay, reject, or fragment provider reimbursements; and

WHEREAS, to date, forty providers are still owed ten to fifteen per cent of the total claims that they had billed from 2003, representing about $7,000,000 to $8,000,000 in unpaid billings; and

WHEREAS, further compounding of the problems are the dual responsibilities shared by the Department of Human Services and the Department of Health for processing developmental disability provider payments; and

WHEREAS, the Department of Health certifies the accuracy and validity of each claim while the Department of Human Services processes the claims for payment, through its fiscal agent, the Affiliated Computer Services, Inc.; and

WHEREAS, there has been positive collaborative efforts between the Department of Health, Department of Human Services, and Affiliated Computer Services, Inc. to resolve the timely payment issues and these efforts need to continue; and

BE IT RESOLVED by the Senate of the Twenty-Second Legislature of the State of Hawaii, Regular Session of 2004, the House of Representatives concurring, that the Department of Health and the Department of Human Services are requested to work collaboratively to address the issue of prompt and timely payment to developmental disability providers; and

BE IT FURTHER RESOLVED that the departments are requested to take immediate action to complete the following tasks:

(1) A status update on corrections made to resolve the billing and claims processing problem;

(2) An investigation of alternative methods of speeding up the processing of claims within thirty days upon receipt of the claim;

(3) Immediate advance payment to those developmental disability providers whose claims are still unpaid;

(4) Identify the specific problems with short term and long term solutions to speeding up the processing of claims on a timely basis;

(5) Identify statutes, administrative rules, policies, and directives to revise or adopt to encourage the timely processing of claims;

(6) Determine and define "timely" with specific number of days; and

(7) Determine whether to eliminate the prior authorization requirement; and

BE IT FURTHER RESOLVED that the departments are further requested to submit a report on a quarterly basis during the interim beginning July 1, 2004, to the Legislature regarding the progress and status of the tasks described above; and

BE IT FURTHER RESOLVED that the departments are further requested to submit findings and recommendations to the Legislature not later than June 30, 2004; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, Director of Human Services, Executive Administrator of the State Council on Developmental Disabilities, Executive Director of Arc of Kauai, Executive Director of Arc of Hawaii, President of Healthcare Association of Hawaii, Chief Executive Officer of Affiliated Computer Services, and the Executive Director of the Hawaii Waiver Provider Association.

Report Title:

Health; Human Services