Bill Text: HI SB1132 | 2021 | Regular Session | Amended
Bill Title: Relating To The Medicaid Sustainability Program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2021-03-11 - Referred to HHH, FIN, referral sheet 22 [SB1132 Detail]
Download: Hawaii-2021-SB1132-Amended.html
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THE SENATE |
S.B. NO. |
1132 |
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THIRTY-FIRST LEGISLATURE, 2021 |
S.D. 2 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO THE MEDICAID SUSTAINABILITY PROGRAM.
BE IT ENACTED
BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION
1. The legislature finds that the healthcare
system in the State faces major financial challenges in ensuring access to quality
healthcare for Hawaii residents due to the coronavirus disease 2019 (COVID-19) pandemic
and related financial and budgetary pressures. Additional federal funding to help financially
sustain Hawaii's healthcare system and medicaid program may be accessed through
a provider fee.
Provider fees are used in forty-nine states and the District of Columbia
as a means of drawing down federal funds to sustain state medicaid programs due
to rising state budget deficits, increasing health care costs, and expanding medicaid
enrollment. Of these, sixteen states use
health insurer provider fees to draw down federal funds.
The legislature further finds that medicaid is jointly financed by
federal and state governments by statutory formula. The federal government pays between fifty per
cent and seventy-four per cent of medicaid costs incurred by a state for care delivered
to its medicaid beneficiaries. Federal assistance
percentages vary by state, with states that have lower per capita incomes receiving
higher federal matching rates. Under federal rules, the state share must be paid
through public funds that are not federal funds.
Provider fees, which are collected
from specific categories of health care providers, may be imposed on different classes
of health care services, including the revenue of health insurers.
The legislature also finds that, in Hawaii, a medicaid sustainability
fee assessed on health insurers would help guarantee access to critical medicaid
benefits, such as supportive housing, behavioral health, vaccinations, preventive
health, primary care, and home- and community-based services at a time when constraints
on the State's budget due to the
COVID-19 pandemic may force reductions in payments. As such, the provider fee would help preserve
access to health care for the medicaid population, which would benefit health insurers
in the State. Medicaid coverage helps reduce
uncompensated care costs that lead to higher costs for health care insurance premiums. Medicaid helps sustain the State's entire healthcare
system as a whole.
The purpose of this Act is to ensure access to health care for medicaid recipients by:
(1) Establishing a medicaid sustainability fee assessed on health insurers;
(2) Establishing a medicaid sustainability program special fund to receive money from
the medicaid sustainability fee and federal medicaid matching funds; and
(3) Providing for the use of
moneys in the medicaid sustainability program special fund.
SECTION 2. The Hawaii Revised
Statutes is amended by adding a new chapter to be appropriately designated and to
read as follows:
"CHAPTER
MEDICAID SUSTAINABILITY PROGRAM
§ -1 Title. This chapter shall be known and may be cited
as the "Medicaid Sustainability Program Act".
§ -2
Findings and declaration of necessity. It is the intent of the legislature to establish
a medicaid sustainability program that would assess a medicaid fee on health insurers,
establish a special fund within the state treasury to receive revenue from the medicaid
sustainability fee to be administered by the department, and use the revenue from
the fee and associated federal medicaid matching funds to fund healthcare services
covered under medicaid and for other purposes as set
forth in this chapter.
§ -3 Definitions. As used in this chapter:
"Department" means the department of human services.
"Fiscal year" means a twelve-month period from July 1 of
a particular calendar year to June 30 of the following calendar year, inclusive.
"Health insurer" means a self-insured plan, a group health
plan as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, a health service benefit plan, a mutual benefit society,
a health maintenance organization, a managed care organization, or other party that
is, by statute, contract, or agreement, legally responsible for payment of a claim
for a health care item or service.
"Health insurer" does not include
not-for-profit health plans.
"Member month" means the total number of individuals for
whom the health insurer has recognized revenue for one month. If revenue is for only part of a month for an
individual, a prorated partial member month may be counted. Member months do not include individuals enrolled
in short-term medical, noncomprehensive medical, specified disease, limited benefit,
accident only, accidental death and dismemberment, disability income, long-term
care, medicare supplemental, stand-alone dental, dental, pharmacy benefit manager,
medicare, medicare advantage, medicare part D, vision, prescription, TRICARE, other
federal insurance, and other individual medical insurance.
§ -4 Medicaid sustainability
program special fund. (a) There is established in the state treasury the
medicaid sustainability program special fund, to be administered by the department,
into which shall be deposited all moneys collected under this chapter.
(b) Moneys in the medicaid sustainability program special fund shall consist of:
(1) All revenue received by the department from the medicaid sustainability fee;
(2) All federal medicaid funds received by the department as a result of matching expenditures made with the medicaid sustainability fee;
(3) Any interest or penalties levied in conjunction with the administration of this chapter; and
(4) Any designated appropriations,
federal funds, donations, gifts, or moneys from any other sources.
(c) Moneys in the medicaid
sustainability program special fund shall be used exclusively to fund healthcare
services covered under medicaid and operations to support the administration of
the medicaid program.
§ -5 Medicaid sustainability fee. (a) Effective July 1, 2021, or the effective
date of any necessary federal approvals, whichever date is later, the department
shall charge and collect provider fees,
to be known as the medicaid sustainability fee, on health insurers.
(b) The medicaid sustainability
fee shall be based on the number of member months of health insurers located within
this State, during the year ending December 31 of the preceding year.
(c) The department shall assess fees based on four
tiers of member months as follows:
(1) Tier one is more than zero up to 75,000 member months;
(2) Tier two is more than 75,000 up to 375,000 member months;
(3) Tier three is more than 375,000 up to 500,000 member months; and
(4) Tier four is more than 500,000 up to 4,000,000 member months.
(d) The department shall adopt rules on the medicaid
sustainability fees. The fees may be assessed
up to $12 for tier one per medicaid member month and up to $15 for tier two per
medicaid member month; and up to $1.00 for tier one per non-medicaid member month.
(e) The department may modify
the fees assessed for the medicaid sustainability program;
provided that the modification is necessary to obtain federal waiver approval consistent
with the requirements of 42 Code of Federal Regulations section 433.68(e)(2).
§ -6 Medicaid sustainability fee assessments. (a) Health insurers shall
pay the medicaid sustainability fee to the department in accordance with this chapter. The fee shall be divided and paid in twelve equal
installments on a monthly basis.
(b) The department shall collect,
and each health insurer shall pay, the medicaid
sustainability fee not later than the thirtieth day after the end of each calendar
month.
§ -7 Federal approval. The department shall seek waivers
and any additional approvals from the Centers for Medicare and Medicaid Services
that may be necessary to implement the medicaid sustainability program.
§ -8 Penalties for failure to pay the medicaid sustainability
fee. If a health insurer fails to pay the full amount
of any medicaid sustainability fee when due, the health insurer shall pay a penalty
equal to prime, plus two per cent, of the fee that was not paid when due. Any subsequent payments shall be credited first to unpaid fee amounts, beginning with the most delinquent
installment, rather than to the penalty or interest amounts. The department may waive the penalties of this
section for reasonable cause.
§ -9 Special designation of medicaid sustainability
program special fund. Notwithstanding section 37-53, and any law or
any administrative rule to the contrary, the specific purposes set out in section -4(c) are established as being the exclusive
uses of the medicaid sustainability program special fund. The medicaid sustainability program special fund
shall not be used for any other purposes, notwithstanding any authority granted
to the governor or any other state official by any other statutory provisions relating
to the allocation or reallocation of funds."
SECTION 3. Section 36-27, Hawaii Revised Statutes,
is amended by amending subsection (a) to read as follows:
"(a)
Except as provided in this section, and notwithstanding any other law to
the contrary, from time to time, the director of finance, for the purpose of defraying
the prorated estimate of
central service expenses of government in relation to all special funds, except
the:
(1) Special out-of-school time instructional program fund under section 302A-1310;
(2) School cafeteria special funds of the department of education;
(3) Special funds of the University of Hawaii;
(4) State educational facilities improvement special fund;
(5) Convention center enterprise special fund under section 201B-8;
(6) Special funds established by section 206E-6;
(7) Aloha Tower fund created by section 206J-17;
(8) Funds of the employees' retirement system created by section 88-109;
(9) Hawaii hurricane relief fund established under chapter 431P;
(10) Hawaii health systems corporation special funds and the subaccounts of its regional system boards;
(11) Tourism special fund established under section 201B‑11;
(12) Universal service fund established under section
269‑42;
(13) Emergency and budget reserve fund under section
328L‑3;
(14) Public schools special fees and charges fund
under section 302A-1130;
(15) Sport
fish special fund under
section 187A-9.5;
[[](16)[]]Neurotrauma special fund under section 321H-4;
[[](17)[]]Glass
advance disposal fee established
by section 342G-82;
[[](18)[]]Center for nursing special fund under section
304A‑2163;
[[](19)[]]Passenger
facility charge special fund established by section 261-5.5;
[[](20)[]]Solicitation of funds for charitable purposes special
fund established by section 467B-15;
[[](21)[]]Land
conservation fund established
by section 173A‑5;
[[](22)[]]Court
interpreting services revolving
fund under section 607-1.5;
[[](23)[]]Trauma
system special fund under
section 321-22.5;
[[](24)[]]Hawaii
cancer research special
fund;
[[](25)[]]Community
health centers special fund;
[[](26)[]]Emergency
medical services special fund;
[[](27)[]]Rental
motor vehicle customer facility
charge special fund established under section 261-5.6;
[[](28)[]]Shared
services technology special fund under section 27-43;
[[](29)[]]Automated
victim information and notification system special fund established under section
353-136;
[[](30)[]]Deposit
beverage container deposit
special fund under section 342G-104;
[[](31)[]]Hospital
sustainability program special
fund under [[]section 346G-4[]];
[[](32)[]]Nursing
facility sustainability
program special fund under [[]section 346F-4[]];
[[](33)[]]Hawaii
3R's school improvement fund under section 302A-1502.4;
[[](34)[]]After-school
plus program revolving fund under section 302A-1149.5; [and]
[[](35)[]]Civil
monetary penalty special
fund under section 321‑30.2[,]; and
(36) Medicaid
sustainability program special fund under section -4,
shall
deduct five per cent of all receipts of all other special funds, which deduction
shall be transferred to the general fund of the State and become general realizations
of the State. All officers of the State and
other persons having power to allocate or disburse any special funds shall cooperate
with the director in effecting these transfers.
To determine the proper revenue base upon which the central service assessment
is to be calculated, the director shall adopt rules pursuant to chapter 91 for the
purpose of suspending or limiting the application of the central service assessment
of any fund. No later than twenty days prior
to the convening of each regular session of the legislature, the director shall
report all central service assessments made during the preceding fiscal year."
SECTION 4.
Section 36-30, Hawaii Revised Statutes,
is amended by amending subsection (a) to read as follows:
"(a) Each special fund,
except the:
(1) Special
out-of-school time instructional program fund under section 302A-1310;
(2) School
cafeteria special funds of the department of education;
(3) Special
funds of the University of Hawaii;
(4) State
educational facilities improvement special fund;
(5) Special
funds established by section 206E-6;
(6) Aloha
Tower fund created by section 206J-17;
(7) Funds
of the employees' retirement system created by section 88-109;
(8) Hawaii
hurricane relief fund established under chapter 431P;
(9) Convention
center enterprise special fund established under section 201B-8;
(10) Hawaii
health systems corporation special funds and the subaccounts of its regional system
boards;
(11) Tourism
special fund established under section 201B‑11;
(12) Universal
service fund established under section 269‑42;
(13) Emergency
and budget reserve fund under section 328L‑3;
(14) Public
schools special fees and charges fund under section 302A-1130;
(15) Sport
fish special fund under section 187A-9.5;
[[](16)[]]Neurotrauma
special fund under section 321H-4;
[[](17)[]]Center
for nursing special fund under section 304A‑2163;
[[](18)[]]Passenger
facility charge special fund established by section 261-5.5;
[[](19)[]]Court
interpreting services revolving fund under section 607-1.5;
[[](20)[]]Trauma
system special fund under section 321-22.5;
[[](21)[]]Hawaii
cancer research special fund;
[[](22)[]]Community
health centers special fund;
[[](23)[]]Emergency
medical services special fund;
[[](24)[]] Rental motor vehicle customer facility charge
special fund established under section 261-5.6;
[[](25)[]]Shared
services technology special fund under section 27-43;
[[](26)[]]Nursing
facility sustainability program special fund established pursuant to [[]section
346F-4[]];
[[](27)[]]Automated
victim information and notification system special fund established under section
353-136;
[[](28)[]]Hospital
sustainability program special fund under [[]section 346G-4[]]; [and]
[[](29)[]]Civil
monetary penalty special fund under section 321‑30.2[,]; and
(30) Medicaid
sustainability program special fund under section -4,
shall be responsible for its
pro rata share of the administrative expenses incurred by the department responsible
for the operations supported by the special fund concerned."
SECTION 5.
There is appropriated out of the medicaid sustainability program special
fund the sum of $100,000,000 or so much thereof as may be necessary for fiscal year
2021-2022 and the same sum or so much thereof as may be necessary for fiscal year
2022-2023 for the purposes of the medicaid sustainability program.
The sums appropriated shall be expended by the department of human services
for the purposes of this Act.
SECTION 6.
Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 7. This Act shall take effect on July 1, 2050, and shall be repealed on December 31, 2023; provided that section -4, Hawaii Revised Statutes, in section 2 of this Act and sections 3 and 4 of this Act shall be repealed on June 30, 2024.
Report Title:
Medicaid Sustainability Program; Appropriation
Description:
Establishes the Medicaid Sustainability Program for 2 years. Appropriates funds out of the Medicaid Sustainability Program Special Fund for fiscal years 2021-2022 and 2022-2023. Sunsets on 12/31/2023. Effective 7/1/2050. (SD2)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
