HOUSE OF REPRESENTATIVES	H.C.R. NO.	294
TWENTY-FOURTH LEGISLATURE, 2007
STATE OF HAWAII

HOUSE CONCURRENT

RESOLUTION

ReQUESTING an audit of the Hawaii State Quest Program to evaluate its current performance in stabilizing health care costs and expanding access to health care services IN HAWAII.

     WHEREAS, the Hawaii State QUEST (Quality of Care, Universal Access, Efficient Utilization, Stable Cost, and Transformation) Program (QUEST) began in 1994 as a federally approved, statewide Section 1115 Medicaid waiver demonstration project which sought to address the State's need to stabilize health care costs, use resources more efficiently, and expand access to health care services, with an emphasis on preventive health care; and

     WHEREAS, QUEST, within the Department of Human Services (DHS) uses a managed care approach, as permitted under Medicaid, which replaced the traditional fee‑for-service system; and

     WHEREAS, the fee-for-service arrangement can be more costly than managed care because it exercises less control over patient visits, has greater potential for unnecessary medical procedures or services, and has greater chance of claims fraud; and

     WHEREAS, an audit conducted by the the Auditor in 1996 found that the project had been inadequately planned and hastily implemented, resulting in management problems and the inability to substantiate its effectiveness and efficiency claims; and

     WHEREAS, a 2003 audit by the Auditor entitled Follow-Up Audit of the Department of Human Services' QUEST Demonstration Project also found that:

(1)  While the Med-QUEST Division has overcome some operational weaknesses, other management control and staffing problems still hamper QUEST's operations;

(2)  There continue to be problems with the eligibility review process, with case file records that lack proper documentation that eligibility has been reviewed, and are incomplete and inconsistent;

(3)  The Oahu office, with the highest caseload per staff member, had the most incomplete case files and 47 percent of the Oahu case files the Auditor sampled lacked adequate documentation of eligibility reviews; and

(4)  The Med-QUEST Division still lacked a standard procedures manual to guide its operations;

and

     WHEREAS, the Auditor in the 2003 audit made several recommendations to improve QUEST, including that DHS evaluate the time and resources (human, financial, and physical) necessary to continue or expand, or both, the QUEST Demonstration Project; and

     WHEREAS, there continues to be unresolved problems, issues, and questions regarding QUEST and the proper management of millions of dollars of state and federal funds; now, therefore,

     BE IT RESOLVED by the House of Representatives of the Twenty-fourth Legislature of the State of Hawaii, Regular Session of 2007, the Senate concurring, that the Auditor is requested to perform an audit of QUEST to evaluate its current performance in stabilizing health care costs and expanding access to health care services; and

     BE IT FURTHER RESOLVED that the Auditor report findings and recommendations to the Legislature 20 days prior to the convening of the Regular Session of 2008; and

     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor, Governor, and Director of Human Services.

OFFERED BY:

_____________________________

Report Title: 

Hawaii State QUEST Program; Audit