SB911 HD1

Report Title:

QUEST; Appropriations; Removal of Financial Disincentives

Description:

Removes financial disincentives for health plans and providers to actively reach out to high-risk populations. Extends coverage of the Children's Health Insurance Program. Restores QUEST benefits to income-eligible immigrants and migrants during and up to three months after pregnancy. (SB911 HD1)

THE SENATE	S.B. NO.	911
TWENTY-FIRST LEGISLATURE, 2001		S.D. 1
STATE OF HAWAII		H.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 preventative health care for its residents, including children and immigrants. 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 purpose of the Act is to:

(1) Remove financial disincentives for health plans and providers to actively reach out to high-risk populations including:

(A) High-risk pregnant women and girls;

(B) Native Hawaiians with early onset of chronic disease; and

(2) Extend coverage of the children's health insurance program to allow children whose family's income is at or below three hundred percent of the federal poverty level to be eligible for health insurance under the QUEST program for the State of Hawaii; and

(3) Restore Med-QUEST benefits to income-eligible legal immigrants and migrants during and up to three months after pregnancy with state-only funds.

PART I

SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding four new sections 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 moneys budgeted for perinatal services including obstetric and other delivery costs. 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.

§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 services associated with methamphetamines and related drugs beginning July 1, 2002.

§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:

"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:

(A) Assessment of the client's needs and personal support system;

(B) Development of a written, comprehensive, individualized service plan including goal development;

(D) Client monitoring to assess efficacy of the plan; or

(E) Periodic reevaluation and adaptation of the plans as necessary.

"Outreach services" means locating high need, resistant to services, or hope bound individuals by developing and using 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 human service and resource use. Types of contact include but are not limited to case finding, education, other engagement strategies, information and referral, and follow-up. Specific examples for this type of service include home visiting for:

(A) Missed prenatal care visits;

(B) Newborn assessment and care training; or

(C) Contacting patients without phones and including assistance in completing necessary QUEST administrative requirements to remain QUEST eligible.

"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; and

(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.

§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 chapter."

SECTION 3. 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 additional staffing of the department of human service to effectuate the purpose of this part.

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

PART II

SECTION 4. The legislature finds that the federal children's health insurance program provides Hawaii with an important opportunity to expand health care coverage to low-income children who are uninsured. The children's health insurance program is considered the largest expansion of health care coverage since the enactment of Medicare and Medicaid.

Children and most adolescents are usually dependent on parents and caregivers for access to health care to maintain good health. When they become sick or are injured, most children and adolescents have access to a health care professional or service. However, too many children and adolescents in the United States, particularly those from poor families or in rural or isolated communities, are at risk for multiple health problems because they lack health insurance or access to a primary care provider. Indigent children may experience two to three times the usual incidence of certain medical conditions, many of which are preventable. Even those adolescents who have health insurance and a primary care provider do not readily seek medical care and their parents or caregivers find it difficult to maintain regular visits to the pediatrician or family doctor for their teenagers. The most common health problems affecting children and adolescents today include injuries, chronic illnesses such as asthma, and mental health problems. In addition, adolescents and pre-adolescents are now engaging frequently in risky behavior that may lead to health problems, including smoking, alcohol, illegal drugs, and unsafe sex.

The legislature finds that the concept of universal access will facilitate preventive health practices. However, the legislature understands that developing a comprehensive and integrated approach to improve children's health requires more outreach, education, and awareness of good public and personal health practices.

Collaboration, communication, and cooperation among schools, parents, students, community agencies, and organizations are essential to establishing a successful school and community health system that addresses the health needs of all children. Over time, this will ensure a seamless system of prevention, early intervention, and when necessary, care of every child.

The purpose of this part to allow children whose family income is at or below three hundred per cent of the federal poverty level to be eligible for health insurance under the State's Med-QUEST program.

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2001-2002 for the children's health insurance program to be funded from existing funds within the ten per cent allocation of the Tobacco Settlement Fund.

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

PART III

SECTION 6. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§346- Medical assistance to legal immigrants and migrants. The department shall provide state-funded medical assistance during the course of pregnancy and up to three months post-partum for:

(1) Legal permanent residents who arrived in the United States after August 22, 1996;

(2) Persons who are permanently residing in the United States under color of law; and

(3) Persons from member countries of the Compacts of Free Association;

who are otherwise eligible for benefits under the State's Medicaid programs, including QUEST, but are ineligible because of restricted eligibility rules imposed by Title XXI of the Social Security Act in the federal Balanced Budget Act of 1997 or the Personal Responsibility and Work Reconciliation Act of 1996."

PART IV

SECTION 7. New statutory material is underscored.

SECTION 8. This Act shall take effect on July 1, 2001.