HOUSE OF REPRESENTATIVES

H.B. NO.

2774

TWENTY-FIFTH LEGISLATURE, 2010

H.D. 2

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO HUMAN SERVICES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§346-    QUEST managed care plans.  (a)  In contracting with managed-care organizations for the provision of medicaid benefits under the QUEST program, the department shall ensure:

     (1)  That each managed-care health plan includes provisions for a co-payment, which shall be not less than $5 and not more than $20 for each:

         (A)  Office visit;

         (B)  Filling or re-filling of prescription drugs;

         (C)  Outpatient service; and

         (D)  Emergency-room visit; provided that these co-payments shall not be applied to inpatient admission or services;

     (2)  The review of proposed co-payment schedules in each managed-care health plan prior to implementation by the managed-care organization;

     (3)  That a formulary for prescription-drug coverage is developed and mandated for use by each managed-care health plan; and

     (4)  The application of the medical necessity provision pursuant to section 432E-1.4 with respect to health care coverage provided under each managed-care health plan.

     (b)  The provisions of subsection (a) shall apply after January 1, 2011, and shall be restricted to the provision of medical benefits to non-pregnant adults over eighteen years of age.

     (c)  The department shall report annually to the legislature on the aggregate number of recipients receiving benefits under both QUEST and a private health care plan no later than twenty days prior to the convening of each regular session."

     SECTION 2.  New statutory material is underscored.

     SECTION 3.  This Act shall take effect on July 1, 2020.

 

Report Title:

Department of Human Services; QUEST

 

Description:

Requires the Department of Human Services to include certain provisions in each contract with managed care organizations for the provision of Medicaid benefits under QUEST.  Effective July 1, 2020.  (HB2774 HD2)

 

 

 

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