HR122 HD1.DOC

WHEREAS, Medicaid and Medicare enrollees are a particularly vulnerable population; and

WHEREAS, Medicaid and Medicare enrollees have high healthcare expenditures, receive fragmented care, have multiple healthcare related identification cards, and may be unsure of who to call for help; and

WHEREAS, providers who serve Medicaid and Medicare recipients must submit both Medicaid and Medicare claims and navigate two separate prior authorization, coverage, and other administrative processes; and

WHEREAS, the Centers for Medicare and Medicaid Services has proffered the opportunity for demonstrations to integrate primary, acute, behavioral health, and long-term care services; and

WHEREAS, the Department of Human Services already has Centers for Medicare and Medicaid Services-approved QUEST Expanded Access Medicaid managed care health plans that include Centers-approved dual eligible special needs plans; and

WHEREAS, future QUEST Expanded Access health plans with dual eligible special needs plans would be expected to join an integration demonstration implemented by the Department of Human Services; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-sixth Legislature of the State of Hawaii, Regular Session of 2012, that the Department of Human Services is requested to implement a demonstration project to integrate care for individuals enrolled in both Medicaid and Medicare in order to improve patient-centeredness and quality of care, help reduce providers' administrative burden, and generate savings to the state and federal governments; and

BE IT FURTHER RESOLVED that the Department of Human Services is requested to optimize participation in the integration demonstration while preserving consumer choice; and

BE IT FURTHER RESOLVED that the Department of Human Services is requested to mitigate the impact of the demonstration project on competing Centers-approved dual eligible special needs plans that are not QUEST Expanded Access Medicaid managed care health plans by ensuring that traditional Medicare only members will be enrolled in the integration demonstration; and

BE IT FURTHER RESOLVED that the Director of Human Services is requested to submit an informative report to the Legislature on the Department's implementation plan for the integration demonstration no later than twenty days before the convening of the Regular Session of 2013 detailing its plan and Memorandum of Agreement with the Centers for Medicare and Medicaid Services, including but not limited to information regarding:

(1) Public notice and meaningful consumer and other stakeholder engagement;

(2) Enrollment targets and related outreach initiatives;

(3) Integrated care management across primary, acute, behavioral health, and long-term services and supports;

(4) Certifiable estimates of expected savings from the Office of the Actuary of the Centers for Medicare and Medicaid Services;

(5) Integrated beneficiary level claims data for program management and evaluation;

(6) Adequacy of access to networks of medical and supportive services providers;

(7) Monitoring and oversight infrastructure;

(8) Quality measurement infrastructure;

(9) Implementation timeline; and

(10) Necessary proposed legislation; and

BE IT FURTHER RESOLVED that the Director of Human Services submit a subsequent detailed report of findings, challenges, and recommendations, including necessary proposed legislation, no later than twenty days before the convening of the Regular Session of 2014; and

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

Report Title:

Department of Human Services; Demonstration Project; Healthcare Integration; Medicaid and Medicare

HOUSE OF REPRESENTATIVES	H.R. NO.	122
TWENTY-SIXTH LEGISLATURE, 2012		H.D. 1
STATE OF HAWAII