THE SENATE	S.C.R. NO.	179
TWENTY-FIFTH LEGISLATURE, 2010		S.D. 2
STATE OF HAWAII

SENATE CONCURRENT

RESOLUTION

REQUESTING THE DEVELOPMENT OF PROPOSED LEGISLATION MANDATING THE SIZE AND EXTENT OF A MANAGED CARE PLAN'S SPECIALTY NETWORK.

     WHEREAS, the Legislature has given broad authority to the Department of Human Services in section 346-14 of the Hawaii Revised Statutes to "administer the medical assistance programs for eligible public welfare and other medically needy individuals by establishing standards, eligibility, and health care participation rules, payment methodologies, reimbursement allowances, systems to monitor recipient and provider compliance and, and assuring compliance with federal requirements to maximize federal financial participation"; and

     WHEREAS, managed care programs such as "Hawaii QUEST" and "QUEST Expanded Access" are a type of medical assistance program developed by the Department of Human Services to provide Medicaid health care services to clients through their health plan; and

     WHEREAS, there are reports that the two health plans that the Department of Human Services has awarded contracts to under the QUEST Expanded Access programs do not have adequate networks of primary care providers; and

     WHEREAS, concerns have arisen that the State lacked adequate assurances from the two health plans regarding the ability of the plans to deliver services; and

     WHEREAS, these concerns have led to lawsuits in the federal courts to block the contract awards under the QUEST Expanded Access programs; and

     WHEREAS, it appears that rather than delegating those functions to the Department of Human Services, the Legislature needs to directly establish those standards, eligibility requirements, and health care participation rules, as well as payment methodologies, reimbursement allowances, and systems to monitor recipient and provider compliance; and

     WHEREAS, a source precedent is the current QUEST request for proposal (RFP) requirements, a purpose of which is to ensure that subscribers and enrollees are able to access and receive health and medical services rendered in a manner providing continuity of care; and

     WHEREAS, under Hawaii law, the current QUEST RFP requirements were issued to potential health care service plans to assure the public that these plans meet certain minimum standards; now, therefore,

     BE IT RESOLVED by the Senate of the Twenty-fifth Legislature of the State of Hawaii, Regular Session of 2010, the House of Representatives concurring, that the Governor is requested to develop proposed legislation to mandate the size and extent of a managed care plan's specialty network based upon the Hawaii QUEST RFP requirements for both QUEST and QUEST Expanded Access Plans; and

     BE IT FURTHER RESOLVED that the proposed legislation require managed care plans to certify that they have a contracted network that at least meets the mandated standards prior to receiving any contract award for either QUEST or QUEST Expanded Access to protect beneficiaries and providers of care from being forced to contract with a managed care plan that does not meet the standards; and

     BE IT FURTHER RESOLVED that for federally designated Medically Underserved Areas, access to transportation, translation, and outreach services be provided in a timely manner; and that for QUEST Expanded Access additional requirements for case management agencies, nursing facilities, and long-term care would be applicable; and

     BE IT FURTHER RESOLVED that the Governor is requested to direct the participation and assistance of any appropriate agencies and personnel within the executive branch needed to develop the proposed legislation; and

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

Report Title: 

Managed Care; California