SB1310.DOC

SECTION 1. The legislature finds that the QUEST expanded access program was established to provide aged, blind, or disabled medicaid recipients with coordinated case management, improved access to healthcare, and a better quality of services. However, the companies with whom the department of human services contracted to provide such expanded access services are unable to offer the culturally-aware, community-based care that is the hallmark of local medical homes. The companies have also failed to contract with geographically diverse primary care providers, adding another obstacle to accessing service for patients located in underserved locations.

The legislature further finds that two medical homes located on Oahu, Waianae Coast Comprehensive Health Center and the Waimanalo Health Center, provide cultural, community-based services, including integrated behavioral services, which are vital to the populations they serve. These medical homes are uniquely situated to provide services to the patient populations in their geographic area based on their integration with and dedication to their respective communities. The Waianae Coast Comprehensive Health Center and the Waimanalo Health Center benefit not only their patients, but the communities in which they are situated, as well. For example, the Waianae Coast Comprehensive Health Center is the largest employer on the Waianae Coast, and serves as an economic engine in this low‑income area.

Additionally, the legislature finds that allowing QUEST expanded access recipients to opt out of QUEST and select an alternative service plan will save the State money, expand the geographic distribution of primary care providers, promote community-based medical home models, and allow for state money to remain and be reinvested in Hawaii. Giving patients a choice of plans will also give the State the opportunity to compare the quality, costs, and benefits of healthcare services offered by different providers.

The purpose of this Act is to require the department of human services to allow QUEST expanded access recipients the choice to opt out of the QUEST plan and receive services through AlohaCare from medical homes located in Waimanalo and Waianae.

SECTION 2. (a) There is established the medical home health care program to offer healthcare services to QUEST expanded access recipients who desire to receive services from Waianae Coast Comprehensive Health Center or the Waimanalo Health Center. Under this program:

(1) Patients enrolled in QUEST expanded access shall be offered the opportunity to opt out of the QUEST expanded access program and receive services from either the Waianae Coast Comprehensive Health Center or the Waimanalo Health Center through the AlohaCare health plan;

(2) The department of human services shall be required to offer AlohaCare a contract to manage the care of these patients at a capitation rate of one per cent below the rate paid to the lowest bidder for the 2007 QUEST expanded access program request for proposals;

(3) AlohaCare plan service providers shall offer all services offered by QUEST expanded access plans as provided in paragraph (1) and shall produce evidence of a provider network sufficient to deliver all services to the legislature no later than July 1, 2009;

(4) In addition to the requirements described in paragraph (3), medical homes providing services under AlohaCare shall provide community participation opportunities, job training services, services required of federally qualified health centers, and traditional Hawaiian healing services; and

(5) A pay-for-performance component shall be established to give the medical homes financial incentives to seek measurable improvements in the health of their patient populations.

(b) The department of human services shall reimburse AlohaCare for the provision of services to patients formerly enrolled in the QUEST expanded access program who have chosen to opt out of the program in favor of receiving services from the Waianae Coast Comprehensive Health Center or the Waimanalo Health Center through AlohaCare.

SECTION 3. 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 2009-2010 to allow QUEST expanded access recipients the choice of health plans and service providers as provided in this Act.

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

SECTION 4. This Act shall take effect upon its approval; provided that section 3 shall take effect upon July 1, 2009.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1310
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII