Report Title:

QUEST

 

Description:

Appropriates funds to provide enabling services under QUEST.

(SD1)

HOUSE OF REPRESENTATIVES

H.B. NO.

1234

TWENTY-FIRST LEGISLATURE, 2001

H.D. 1

STATE OF HAWAII

S.D. 1

 

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 preventive health care for its residents. In addition to creating a healthier population, access to health care 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 health care providers actively outreach to many high-risk/high-cost patients who otherwise would not seek out primary medical care.

The services delivered by health centers to assure access to otherwise noncompliant patients are called enabling services.

The purpose of this 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 diseases, and chronic substance abusers.

SECTION 2. The QUEST medicaid agency is directed to calculate and withhold from health plan capitalization payments all dollars budgeted for perinatal services including obstetric and other delivery costs. All withheld funds shall then be pooled and distributed by plans retrospectively on a case rate basis when there is a documented pregnancy within the health plan's population. This carve out shall be effective July 1, 2001.

SECTION 3. This Act directs QUEST to request state health plans to provide claims paid data on substance abuse and related behavioral health encounter information for the purpose of assessing the feasibility of a substance abuse carve out beginning July 1, 2002. This initiative will focus on providing services for methamphetamines and other serious drug users in Hawaii.

SECTION 4. This Act directs the department of human services to define enabling services to be provided by QUEST plans to include all of the following:

(1) All federally qualified health center (FQHC) enabling

services covered by medicaid payments prior to

initiation of the QUEST program including those covered under early periodic screening development testing;

(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; and

(3) The following FQHC enabling services (definitions extracted from "Medical Group Management Association

Center for Research" September 2000):

(A) Case management: Documented client-centered service provided either onsite or offsite 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's life management skills and/or the ability to function in the community. 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 access efficacy of the plan; and

(iv) Periodic re-evaluation and adaptation of the plan as necessary; and

(B) Outreach services: Locate high need, resistant services, or home 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, social functioning, or increasing their service and resource utilization. Types of contact include but are not limited to case finding, education, or other engagement strategies, information referral and follow-up. Specific examples of this type of service includes home visiting for

(i) Missed prenatal care visits;

(ii) Newborn assessment and car training; or

(iii) For contacting patients without phones and including assistance in completing necessary QUEST administrative requirements to remain Med-QUEST eligible; and

(C) Supportive counseling services: 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 homeliness, substance abuse, housing, and similar issues can be addressed in this forum.

SECTION 5. The department of human services shall submit for federal review any changes in the state medicaid plan.

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 to provide enabling services under QUEST.

The sum appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 7. This Act shall take effect on July 1, 2003.