H.R. NO.













REQUESTING the centers for medicare & medicaid services to establish criteria and penalties for medicaid patients who do not attend their medical and other health care-related appointments as scheduled.




     WHEREAS, according to the Center for Studying Health System Change, a health policy research and analysis nonpartisan organization, many low-income persons, especially those enrolled in Medicaid or who have no insurance, have difficulty finding physicians who are willing to accept them as patients; and


     WHEREAS, low Medicaid reimbursement rates to physicians, constraints on payments from managed care and other sources, and continued economic disincentives to serve low-income patients are cited as reasons for the low acceptance of Medicaid patients by physicians; and


     WHEREAS, missed appointments by Medicaid patients also contribute to the reluctance of physicians to accept these patients and increases the costs of medical care; and


     WHEREAS, missed appointments also affect patients' health and health outcomes, making them prone to further deterioration and resulting in their receipt of less than the recommended level of care; and


     WHEREAS, "no-show" patients also add to an inefficient health care system by increasing wait times and operational costs for all patients; and


     WHEREAS, a number of factors should be considered in developing strategies to decrease the number of appointments missed by Medicaid patients, including:

(1)  Patient factors, such as memory, cognitive, or mobility problems; substance misuse; personality disorders; and diagnosis;


(2)  Environmental and demographic factors, such as age, homelessness, and transportation to and from the health care facility;


(3)  Clinician factors, such as patient-clinician rapport and communication; and


(4)  Scheduling factors, such as appointment day and time, follow-up appointment intervals, and appointment reminders; and


     WHEREAS, one strategy to decrease Medicaid patient no-shows is to impose penalties on these patients when they fail to show up for their scheduled appointments; now, therefore,


     BE IT RESOLVED by the House of Representatives of the Twenty-sixth Legislature of the State of Hawaii, Regular Session of 2012, that the Centers for Medicare & Medicaid Services is requested to establish criteria and penalties for Medicaid patients who do not attend their medical and other health care-related appointments as scheduled; and


     BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Administrator of the Centers for Medicare & Medicaid Services, the Director of Human Services, and the Director of Health.









Report Title: 

Medicaid Patients; Penalty for Missed Appointments