Bill Text: HI SB1094 | 2010 | Regular Session | Amended
Bill Title: Federally Qualified Health Centers; Patient-centered Health Care
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Engrossed - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB1094 Detail]
Download: Hawaii-2010-SB1094-Amended.html
Report Title:
Health; Federally Qualified Health Centers; Pilot Program; Appropriation
Description:
Establishes a pilot program to direct payment of certain state funds to federally qualified health centers to support federally qualified health centers as patient-centered health care homes. Appropriates funds from federal stimulus legislation. (SD1)
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THE SENATE |
S.B. NO. |
1094 |
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TWENTY-FIFTH LEGISLATURE, 2009 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that, according to the American College of Physicians,
(1) The United States health care system is poorly prepared to meet the current, and particularly the future, health care needs of the aging population;
(2) Health care costs are growing faster than the economy, leaving employers, government, and individuals straining under the financial burden; and
(3) Health care outcomes in the United States are poorer than in other industrialized nations that spend less on their health care systems.
The legislature further finds that our system of private and government-funded health insurance programs emphasize uncoordinated episodic treatment for acute care. Accordingly, a disproportionate amount of resources are paid for specialty, in‑patient, and emergency department visits and procedures compared to payments for good primary and preventive care and care management.
A successful model for health care services known as "the patient-centered health care home" model has resulted in better patient health and lower costs. This model is based on:
(1) Continuity in the relationship between the primary care provider and the patient;
(2) A whole-person/family orientation rather than a disease orientation;
(3) Integration and coordination of patient care;
(4) Processes that increase quality and reduce errors including use of electronic health records, technology that improves communication, and the development and measurement of outcomes; and
(5) Timely access to care that also overcomes any geographic, economic, and cultural barriers.
The legislature further finds that certain individuals and families require additional help to navigate the health care delivery system and to effectively make use of health care services. The services that provide this additional assistance are referred to as "enabling" services and are defined as:
(1) "Case management assessment" which means non-medical assessment that includes the use of an acceptable instrument measuring socioeconomic, wellness, or other non-medical health status;
(2) "Case management treatment facilitation" which means an encounter with a center-registered patient or their household or family member in which the patient's treatment plan is developed or facilitated by a case manager. The plan must incorporate the services of multiple providers or healthcare disciplines;
(3) "Case management referral" which means facilitation of a visit for a registered patient of the center to a healthcare or social service provider;
(4) "Financial counseling/eligibility assistance" which means counseling of a patient presumed to have a family income of three hundred per cent of the poverty level or less that results in a completed application to a sliding fee scale or health insurance program including medicaid or medicare;
(5) "Health education/supportive counseling-individual" which means provision of health education or supportive services to individuals in which wellness, preventive disease management or other improved health outcomes are attempted through behavior change methodology;
(6) "Health education/supportive counseling-group" which means provision of health education or supportive services to groups of twelve or fewer in which wellness, preventive disease management or other improved health outcomes are attempted through behavior change methodology;
(7) "Interpretation" which means the provision of interpreter services by a third party, other than the primary care giver, intended to reduce barriers to a limited English-proficient patient or a patient with documented limitations in writing or speaking skills sufficient to affect the outcome of a medical visit or procedure;
(8) "Outreach" which means patient services that result in the conversion of a patient without a primary care provider to one who has been accepted into a provider's panel;
(9) "Transportation" which means providing direct assistance to a patient by an employee or contractor of a primary care center in which access barriers are reduced for a patient that is assigned to a primary care panel at a community health center; and
(10) "Other" which means any other services provided by an employee or contractor of a primary care center in which access barriers are reduced for a patient that is assigned to a primary care panel at a community health center.
The purpose of this Act is to establish a pilot program to direct payment of certain state funds to federally qualified health centers to support these federally qualified health centers as patient-centered health care homes in order to improve patient care, reduce errors, and save overall costs to the state's health care system.
The federally qualified community health centers located in medically underserved areas or serving medically underserved populations have developed an appropriate model for a patient-centered health care home. The key standards for the model are community participation, cultural appropriateness, training and economic development, and the enabling services described above.
SECTION 2. (a) The department of health shall develop and implement the patient-centered health care homes pilot project, for fiscal years 2009-2010 and 2010-2011, to provide primary health care funding to federally qualified health centers.
(b) Up to seventy-five per cent of the funds shall be used to pay for uninsured services on a fee for service basis as follows:
(1) Level I: $95 per visit, during which the federally qualified health center provides a primary medical, behavioral health, or dental clinical visit, and all enabling services defined above, as needed. In addition, the federally qualified health center will assist uninsured patients with public insurance applications and track and report data on reasons that certain patients remain uninsured;
(2) Level II: $100 per visit, during which all Level I services are provided and, in addition, the federally qualified health center reports on not less than one process or clinical outcome measure, as negotiated with the department of health; and
(3) Level III: $105 per visit, during which all Level I services are provided and, in addition, the federally qualified health center reports on not less than six performance measures negotiated with the department of health.
(c) At least twenty-five per cent of the funds, in addition to whatever portion of funds are not used to pay for the uninsured services on a fee for service basis, shall be used to support strengthening and improving federally qualified health centers including, quality improvement, care management, health information, enhanced access systems, emergency preparedness, and facility improvement.
SECTION 3. The department of health shall submit an interim report, including the progress of the pilot program and its funding sources, to the legislature no later than twenty days prior to the convening of the regular session of 2010. The department of health shall submit a final report including its progress and final recommendations on whether to make the pilot program permanent and any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2011.
SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2009-2010 and the same sum or so much thereof as may be necessary for fiscal year 2010-2011 to provide primary health care funding to federally qualified health centers; provided that only moneys received by the State and deposited into the state general fund pursuant to the federal American Recovery and Reinvestment Act of 2009 may be expended for the purposes of this Act.
The sums appropriated shall be expended by the department of health for the purposes of this Act.
SECTION 5. This Act shall take effect on July 1, 2009.
