Bill Text: HI HR129 | 2017 | Regular Session | Introduced

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Bill Title: Requesting The Insurance Commissioner To Report On Capitated Payment Models By Healthcare Insurance Plans.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 2017-03-14 - Referred to HLT, CPC, referral sheet 30 [HR129 Detail]

Download: Hawaii-2017-HR129-Introduced.html

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HOUSE OF REPRESENTATIVES	H.R. NO.	129
TWENTY-NINTH LEGISLATURE, 2017
STATE OF HAWAII

HOUSE RESOLUTION

 

 

REQUESTING the INSURANCE COMMISSIONER TO REPORT ON CAPITATED payment models BY healthcare INSURANCE PLANS.

 

 

 

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

 

     WHEREAS, the State and counties strive to enhance the health of public employees 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 their 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 anticipates that 90 percent of its 720,000 member-subscribers will be immediately affected by the change and, by the year 2020, the entire State will be converted to the capitated payment model; 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, HMSA asserts that the capitated payment model:

 

     (1)  Encourages medical providers to spend more time with the patients who need the most care;

 

     (2)  Provides flexibility in treating patients who require a lower level of care by encouraging consultation with and treatment of those patients by text message, electronic mail, or telephone; and

 

     (3)  Has providers encourage patients to participate in medical screenings, maintain a regular exercise regimen, and make healthy lifestyle choices; and

 

     WHEREAS, critics claim that capitated payment models are detrimental to quality patient care by:

 

     (1)  Rewarding medical providers who administer treatment to fewer patients at their facilities; and

 

     (2)  Discouraging medical providers from accepting new patients or treating patients who suffer from severe illnesses and require more resources; and

 

     WHEREAS, critics assert that capitated payment models create unfavorable business conditions that:

 

     (1)  Drastically reduce reimbursements to the providers and significantly increase the time required to satisfy HMSA's reporting requirements;

 

     (2)  Require substantial investment to upgrade information technology and increase overhead expense to retain more staff to process the additional documentation;

 

     (3)  Compel practitioners to decline to participate with the patient's HMSA coverage because of the low reimbursement rates; and

     (4)  Exclude independent practitioners from the marketplace and compel practitioners to consider closing their practice; and

 

     WHEREAS, the Insurance Commissioner is the State's expert on mutual benefit societies, accident and health or sickness insurance, HMSA's 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, that the Insurance Commissioner is requested to report on capitated payment models by healthcare insurance plans; and

 

     BE IT FURTHER RESOLVED that this report analyze the impacts of HMSA's capitated payment model with regard to:

 

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

 

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

 

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

 

     (4)  Whether the model deters the formation of new independent healthcare practices;

 

     (5)  EUTF's cost to procure healthcare plans; and

 

     (6)  HMSA's cost to provide healthcare plans and the consequences on healthcare insurance rates and premiums; and

     BE IT FURTHER RESOLVED that the Insurance Commissioner submit a final report of findings and recommendations to the Legislature and conduct an informational briefing for legislators, all affected parties, 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 the Legislature recommends that healthcare insurance carriers do not implement the capitated payment model unless the Insurance Commissioner's final report and the public support at the informational briefing favor the capitated payment model; and

 

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

 

 

 

	OFFERED BY:	_____________________________

Report Title: 

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