HOUSE OF REPRESENTATIVES	H.C.R. NO.	201
TWENTY-NINTH LEGISLATURE, 2017		H.D. 1
STATE OF HAWAII

HOUSE CONCURRENT

RESOLUTION

REQUESTING THE INSURANCE COMMISSIONER TO REPORT ON ALTERNATIVE PAYMENT MODELS BY MEDICARE AND HEALTHCARE INSURANCE PLANS.

     WHEREAS, the Legislature finds that the health and welfare of all of the State's employees and retirees are important priorities of the State; and

     WHEREAS, the State and counties strive to enhance the health of public employees and retirees by maximizing their health plan benefits and, at the same time, minimizing the costs of plans provided by the Hawaii Employer-Union Health Benefits Trust Fund (EUTF); and

     WHEREAS, the preferred provider organization healthcare plans offered by EUTF to the 65,000 active State and county employees are provided by Hawaii Medical Service Association (HMSA); and

     WHEREAS, HMSA plans to convert its primary care provider reimbursement model from a fee-for-service to a capitated payment model by which the provider receives fixed monthly rate payments for each patient in the provider's practice; and

     WHEREAS, HMSA's objectives for the capitated payment model are to improve the overall health of the population, provide quality treatment, and contain rising medical costs; and

     WHEREAS, as of January 2017, 255,215 individuals in Hawaii were enrolled in Medicare health insurance coverage and 180,754 were enrolled in Medicare Part D prescription drug coverage; and

     WHEREAS, for the reporting period ending on June 30, 2016, there were 51,532 EUTF retiree beneficiaries and their dependents enrolled in Medicare health insurance plans and 38,345 enrolled in Medicare prescription drug coverage; and

     WHEREAS, pursuant to the federal Medicare Access and CHIP Reauthorization Act of 2015, Medicare is currently phasing out its flawed payment calculation formula and implementing two innovative frameworks for provider payments, the Merit-based Incentive Payment System and Advanced Alternative Payment Modules, to improve patient care and more fairly reimburse providers; and

     WHEREAS, the Insurance Commissioner is the State's expert on mutual benefit societies, accident and health or sickness insurance, insurers' financial condition, health insurance rate-making, health provider network adequacy, and mandatory health insurance benefits, and is attuned to the healthcare insurance marketplace through complaints from and dialog with consumers, healthcare providers, and healthcare insurers; now, therefore,

     BE IT RESOLVED by the House of Representatives of the Twenty-ninth Legislature of the State of Hawaii, Regular Session of 2017, the Senate concurring, that the Insurance Commissioner is requested to report on alternative payment model programs being adopted by Medicare and local health insurance plans; and

     BE IT FURTHER RESOLVED that this report analyze the impacts of alternative payment models with regard to:

     (1)  The quality and accessibility of healthcare for patients;

     (2)  The costs to operate healthcare provider businesses including independent healthcare providers, healthcare clinics, and hospitals; and

     (3)  The level of reimbursement to healthcare providers and whether the reimbursements are sufficient to ensure the viability of the provider's business; and

     BE IT FURTHER RESOLVED that the Insurance Commissioner is requested to submit a final report of findings and recommendations to the Legislature and conduct an informational briefing for legislators and the general public no later than 20 days prior to the convening of the Regular Session of 2018; and

     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Governor and the Insurance Commissioner.

Report Title: 

Requesting the Insurance Commissioner to Report on Capitated Payment Models by Healthcare Insurance Plans.