Hawaii-2011-SB1468-Amended

PART I

SECTION 1. The legislature finds that improving the medicaid health care system of Hawaii will require a comprehensive and coordinated approach. Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services, has long supported broad system change with linked goals through the "Triple Aim" approach. The Triple Aim focuses on improving the individual experience of care, improving the health of populations, and reducing per capita costs of care for populations. Achieving these interdependent goals in health care requires balance, collaboration, data, and innovation. The legislature finds that one such innovation and opportunity endorsed by the Patient Protection and Affordable Care Act (Public Law 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), together known as the Affordable Care Act, is the patient-centered medical home model, also known as the patient-centered health home.

A patient-centered health home is a model of delivering comprehensive, integrated, and holistic health care services to patients, including preventive and lifestyle health services. It is not necessarily a physical structure, but rather a collection of health care providers and community organizations that work collectively to provide and manage patient health. The primary provider within a health home works with a health care team to provide comprehensive and integrated services to patients. The health home team may include a primary care provider, behavioral health provider, care manager or patient care coordinator, and allied health professionals.

The collaborative nature of the patient-centered health home systematically works to reduce health disparities for patients with multiple chronic diseases like diabetes, hypertension, and depression, which are aggressive drivers of cost. Patient-centered health care homes improve patient outcomes by integrating and coordinating care across the entire continuum of care, providing holistic health care services, and transforming the delivery of health care by moving patient treatment away from acute, incident-based care, toward a more proactive, wellness-oriented, and healthy patient behavior paradigm.

A 1999 study of standard doctor visits published in the "Journal of the American Medical Association" revealed that doctors interrupted patients after twenty-three seconds of problem explanation, and spent just 1.3 minutes giving information. Fifty per cent of patients left without understanding what the doctor said, and ninety-one per cent of patients had no active involvement in their own decision-making process. By having patients take an active and informed role in their own health, and partnering them with a proactive health care team that works collectively to encourage healthy lifestyles, the patient-centered health care home reduces long-term costs by focusing on wellness, education, and preventive services, which not only reduce general health care costs but also more costly emergency room and inpatient facility use.

To facilitate the most efficient use of resources and to enhance patient care through extensive care coordination, a patient-centered health home and the health care team must employ health information technology that enables sharing of patient and treatment data and collection and reporting at the patient and provider level. Health homes should have electronic health record systems that meet the Centers for Medicare and Medicaid Services' federal meaningful use guidelines.

Transformation of health care delivery must simultaneously be accompanied by a reassessment of reimbursement. Given the enhanced level of services provided by patient-centered health care homes, it is essential that organizations operating under this model be reimbursed for the array of services that ultimately contribute to long-term cost savings. The reimbursement model should pay for services provided and outcomes produced. A comprehensive reimbursement strategy for a medicaid health home model includes consistent fee-for-service reimbursement based on existing prospective payment system guidelines, reimbursement for enhanced health care home services, based on a per member per month formula, and organizational incentive payments for improving total population health in the chronic diseases areas identified.

The legislature finds that the Affordable Care Act grants states the option to provide health homes to medicaid enrollees with chronic conditions and receive a ninety per cent federal medical assistance percentage for those enrollees for the first eight fiscal quarters. The legislature further finds that the Affordable Care Act also provides financial support and incentives for health systems that move toward team-based, collaborative methods of care and wellness.

The purpose of part I of this Act is to authorize the establishment of a Hawaii medicaid modernization and innovation task force that may establish a patient-centered health home pilot program within the medicaid program.

SECTION 2. (a) No later than July 1, 2011, there may be established within the department of human services for administrative purposes the Hawaii medicaid modernization and innovation task force to be appointed by the governor as provided in section 26-34. The task force shall be comprised of thirty-five members with geographic representation from across the State as follows:

(1) The chairpersons of the committees with jurisdiction over human services of the respective houses of the legislature, or the chairpersons' designees;

(2) The chairpersons of the committees with jurisdiction over health of the respective houses of the legislature, or the chairpersons' designees;

(3) The director of human services, or the director's designee;

(4) The director of health, or the director's designee;

(5) The state insurance commissioner;

(6) The lieutenant governor;

(7) One representative of a not-for-profit health plan offered as a plan in any state health care program;

(8) One representative of a nonprofit health provider association;

(9) One representative of a local behavioral health professional association;

(10) Six patient-consumer representatives, at least three of whom serve on the board of a federally qualified health center;

(11) One oral health provider;

(12) One representative of the business sector;

(13) One licensed advanced practice registered nurse;

(14) One non-physician mental health provider;

(15) One licensed primary care physician practicing family medicine to be appointed from a list of nominees submitted by the speaker of the house of representatives;

(16) One licensed primary care physician practicing geriatric medicine to be appointed from a list of nominees submitted by the speaker of the house of representatives;

(17) One representative of a health plan offered as a plan in any state health care program to be appointed from a list of nominees submitted by the speaker of the house of representatives;

(18) One representative of any allied or complimentary health profession that provides support to primary care physicians and medical home teams to be appointed from a list of nominees submitted by the speaker of the house of representatives;

(19) One licensed primary care physician practicing pediatric medicine to be appointed from a list of nominees submitted by the president of the senate;

(20) One representative of a local medical professional association to be appointed from a list of nominees submitted by the president of the senate;

(21) One representative of a health plan offered as a plan in any state health care program to be appointed from a list of nominees submitted by the president of the senate;

(22) One representative of any allied or complimentary health profession that provides support to primary care physicians and medical home teams to be appointed from a list of nominees submitted by the president of the senate;

(23) One representative from a hospital;

(24) One representative from a physician's group;

(25) One representative from the health care provider industry;

(26) A physician assistant;

(27) An individual with a finance background; and

(28) A social worker.

(b) To the extent permissible by law and in addition to any other duties prescribed by law, the task force may develop and implement the Hawaii patient-centered health home pilot program. The task force may develop a program that is consumer-driven, culturally appropriate, and family-centered and that optimizes access and provides team-based, integrated, and holistic care delivery. The task force shall:

(1) Adopt a definition, criteria, and standards for health homes that take into consideration the recommendations of the Patient-Centered Primary Care Collaborative Joint Principles of the Patient-Centered Medical Home and the National Committee for Quality Assurance Patient-Centered Medical Home Certification Standards, and is consistent with the definition of "health home services" contained in Title 42 United States Code Section 1396w‑4;

(2) Consult with any local health plan or provider that has implemented a medical home or health home model of care in Hawaii, consider the criteria and standards used by the health plan or provider, and determine whether the criteria and standards are appropriate for inclusion in the task force's criteria and standards for the Hawaii patient-centered health home pilot program;

(3) Certify health homes that meet the standards established by the task force;

(4) Adopt a definition of the medical home team that includes providers within the medical home, including:

(A) A primary care provider;

(B) Behavioral health provider;

(D) Nursing staff;

(E) Nutritionists and dieticians;

(F) Oral health care provider;

(G) Pharmaceutical provider;

(H) Ambulatory care providers; and

(I) Other specialty care providers;

(5) Develop quality and performance measures that certified health homes in the pilot program must report to the task force, health plans, and department of human services;

(6) Develop a payment methodology for certified health homes that shall include a per member per month care coordination fee, consistent fee-for-service reimbursement, payment for any services not reimbursed under current medicaid or prospective payment system guidelines but that are recommended as a covered service in the health home pilot program developed by the task force, and organizational incentive payments for improving total health among chronic disease populations, and other metrics as adopted by the task force; provided that for federally qualified community health centers, the payment methodology is in addition to, and no less than, existing prospective payment system rates; and

(7) Develop annual reporting requirements for certified health homes and health plans to report to the task force, department of human services, and legislature on:

(A) The number of members in the program and characteristics of members including income, ethnicity, language, complex or chronic condition, age, and sex;

(B) The number and geographic distribution of health home providers;

(D) Measures of preventive care;

(E) Health home payment methodology arrangements compared with costs related to implementation and payment of care coordination fees; and

(F) Estimated and actual impact of health homes on health disparities.

(c) The task force shall select a chairperson by a majority vote of its members. A majority of the members serving on the task force shall constitute a quorum to do business. The task force may form workgroups and subcommittees, including individuals who are not task force members, to:

(1) Obtain resource information from medical professionals, insurers, health care providers, community advocates, and other individuals as deemed necessary by the task force;

(2) Make recommendations to the task force; and

(3) Perform other functions as deemed necessary by the task force to fulfill its duties and responsibilities.

(d) Members of the task force shall serve without compensation and shall receive no reimbursement for expenses.

(e) The task force may solicit monetary gifts and donations to offset the costs and expenses of the task force.

(f) The task force may require reports as necessary in the form specified by the task force from state agencies and program and service providers of any state health care program.

(g) No later than twenty days prior to the convening of the regular session of 2012, the task force shall submit to the legislature, the governor, the director of health, and the director of human services a report relating to the development of the program containing:

(1) The progress of the task force; and

(2) Any and all criteria, standards, measurements, payment methodology, and other requirements of the Hawaii patient-centered health home pilot program adopted by the task force pursuant to this section.

(h) No later than twenty days prior to the convening of the regular session of 2013 the task force shall submit to the legislature, the governor, the director of health, and the director of human services a report relating to the implementation of the program containing information and data regarding the problems experienced with the program, benefits of the program, and the practical application of the program. The report shall also contain an opinion as to whether the program is a practical approach to modernizing medicaid-centered health care and recommendations as to whether the program should be continued.

Based on the task force's recommendation, the legislature and the governor may determine whether to continue the Hawaii patient-centered health home pilot program.

(i) The task force shall cease to exist on June 30, 2013.

PART II

SECTION 3. Chapter 327E, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§327E- Advance health-care directive program. There may be established a program within the appropriate agency to encourage Hawaii residents with advance health-care directives to maintain a copy of that advance health-care directive on their person."

PART III

SECTION 4. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§346- QUEST reimbursement modifications. No managed care plan or provider offering services under any QUEST program should modify reimbursement policies, guidelines, interpretation, or positions adopted by medicaid or any agent, whether formally or informally, in writing or orally, without providing a ninety day prior written notice of such change to any affected health care provider. No such modification may be applied retroactively if it would have the effect of reducing reimbursements previously made to such health care providers if prior approval for reimbursement was obtained through medicaid."

PART IV

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 2050.

THE SENATE	S.B. NO.	1468
TWENTY-SIXTH LEGISLATURE, 2011		S.D. 2
STATE OF HAWAII		H.D. 1