Bill Text: HI SR80 | 2010 | Regular Session | Amended
Bill Title: Managed Care; California
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2010-04-09 - (S) Report adopted, as amended (SD 1) and referred to CPN. [SR80 Detail]
Download: Hawaii-2010-SR80-Amended.html
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THE SENATE |
S.R. NO. |
80 |
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TWENTY-FIFTH LEGISLATURE, 2010 |
S.D. 1 |
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STATE OF HAWAII |
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SENATE 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 Medicated 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, one of whose purposes 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, 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 plans will need to certify that they have a contracted network that at least meets these standards prior to receiving any contract award for either QUEST or QUEST Expanded Access in order to protect beneficiaries and providers of care from being forced to contract; and
BE IT FURTHER RESOLVED that for federally designated Medically Underserved Areas, access to transportation, translation, and outreach services will be provided in a timely manner; and that for QUEST Expanded Access additional requirements of 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 Resolution be transmitted to the Governor and the Director of Human Services.
Managed Care; California
