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THE SENATE                           S.C.R. NO.            
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                    SENATE  CONCURRENT
                        RESOLUTION

  REQUESTING AN AUDIT OF THE IMPACT OF MANAGED HEALTH CARE ON THE
    QUEST PROGRAM.
 


 1        WHEREAS, the Hawaii Health QUEST (Quality of Care,
 2   Universal Access, Efficient Utilization, Stable Cost, and
 3   Transformation) is a federally approved, statewide Section 1115
 4   Medicaid waiver demonstration project which seeks to address
 5   the State's need to stabilize health care costs, use resources
 6   more efficiently, and expand access to health care services,
 7   with an emphasis on preventive health care; and
 8   
 9        WHEREAS, QUEST clients include welfare recipients, general
10   assistance recipients, and former State Health Insurance
11   Program (SHIP) members; and
12   
13        WHEREAS, QUEST utilizes a managed care approach, as
14   permitted under Medicaid, which replaced the traditional
15   fee-for-service system; and
16   
17        WHEREAS, the fee-for-service arrangement can be more
18   costly than managed care because it exercises less control over
19   patient visits, has greater potential for unnecessary medical
20   procedures or services, and has greater chance of claims fraud;
21   and
22   
23        WHEREAS, managed care is supposed to realize cost savings
24   by payment of a set monthly fee or payment to a health plan
25   that is responsible for any financial risk; and
26   
27        WHEREAS, the Department of Human Services (DHS)
28   administers the QUEST program; and
29   
30        WHEREAS, many questions have arisen about the propriety
31   and efficacy of managed care in the QUEST program; and
32   
33        WHEREAS, the last Auditor's report on QUEST, Report No.
34   96-19, addressed the operational efficiency of QUEST, but did
35   not audit the managed care system in QUEST; and

 
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 1   
 2        WHEREAS, an audit of the managed care system of QUEST is
 3   necessary for the legislature to adequately assess the
 4   efficiency, fairness, and cost-savings of managed care in the
 5   QUEST program, particularly the dental services program; now,
 6   therefore,
 7   
 8        BE IT RESOLVED by the Senate of the Twentieth Legislature
 9   of the State of Hawaii, Regular Session of 2000, the House of
10   Representatives concurring, that the Auditor is requested to
11   audit the QUEST program's utilization of managed care to
12   determine the efficiency, fairness, and cost-savings of managed
13   care, including dental services; and
14   
15        BE IT FURTHER RESOLVED that the Auditor include an
16   analysis of the relationship between the DHS and the Hawaii
17   Medical Service Association (HMSA) in the dental services
18   program of QUEST to determine whether or not there are any
19   improprieties, ethical conflicts, or adverse impacts on patient
20   care; and
21   
22        BE IT FURTHER RESOLVED that the Auditor seek to determine
23   whether or not HMSA is making excessively large profits from
24   the QUEST dental program; and
25   
26        BE IT FURTHER RESOLVED that the Auditor report findings
27   and recommendations to the legislature twenty days prior to the
28   convening of the Regular Session of 2001; and
29   
30        BE IT FURTHER RESOLVED that certified copies of this
31   Concurrent Resolution be transmitted to the Auditor, Department
32   of Human Services, and Hawaii Medical Service Association.
33 
34 
35 
36                         OFFERED BY:  ____________________________