Hawaii Department of Human Services Seeks Health Plans to Provide Care, Transform Medicaid

News Release from Department of Human Services

HONOLULU, HAWAII – The Department of Human Services Med-QUEST Division today requested for healthcare plans to bid on contracts to improve the state Medicaid programs for low-income residents, known as QUEST. The new contracts will improve access statewide, address cost issues, support new models to manage care for people with chronic diseases, and provide incentives for leveraging information technology to improve people’s health.

“We must address the soaring costs of healthcare,” said Governor Neil Abercrombie. “Changing the way our Medicaid programs operate is an important step toward the healthcare transformation we need in Hawai‘i.”

The request from DHS requires QUEST plans to incorporate essential elements of healthcare transformation. One of these is “patient-centered care” where physicians and other healthcare providers work with patients, especially those with complex health problems and chronic diseases, to better manage and coordinate their care. Another key element is increased use of electronic health records among providers with the goal of increasing quality while reducing medical errors and costs associated with unnecessary or duplicated services.

“Requiring health plans to be licensed in the state and providing incentives for them to operate on every island make sense for Hawai‘i’s economy and will significantly improve access for people in need of care,” said Patricia McManaman, DHS Director. “This administration values the input from the community and we will continue working together to improve healthcare in Hawai‘i.”

Prior to today’s release, DHS sought input from consumers, healthcare providers, and the general public. Suggestions from the community that were incorporated include:

• Requiring QUEST plans to be licensed in Hawai‘i at the time of bid
• Requiring QUEST plans to demonstrate that they have an established and adequate provider network at the time of the bid
• Requiring QUEST plans to improve systems for timely referral and service authorization
• Incentives for QUEST plans to operate statewide

Health plans responding to the new DHS request must provide coverage consistent with the new QUEST-Adult benefits package for 2012. The new QUEST-Adult benefits package includes:

• 10 inpatient days (plus 10 additional acute psychiatric days)
• 20 outpatient visits (plus 6 additional behavioral health visits)
• Laboratory and imaging associated with covered visits
• 3 outpatient hospital/ambulatory surgical center procedures
• Prescription medications
• Family planning/contraceptives
• Diabetes supplies
• Vaccines (pneumonia, influenza, tetanus/diphtheria)
• Limited non–emergency transportation
• Emergency medical
• Emergency dental
• Language access services

Exceptions to the limitations of the QUEST-Adult benefits package are available for:

• Pregnancy-related services
• Cancer treatment
• Organ transplantation

Director McManaman explained the need for the new QUEST-Adult benefit package at several community forums, citing rising healthcare costs, ongoing economic issues, and concerns about future sustainability.

“Current circumstances, as well as the long-term cost trends, required difficult choices to be made,” said Director McManaman. “We are cognizant that these changes will have impacts for our clients, but the new benefits package safeguards the most critical health needs.”

Potential QUEST plans and the public are invited to an orientation on August 15, 2011 in Kapolei to be followed by a question and answer period, during which additional public comment and suggestions will be accepted.

Winning proposals will be determined by December 31, 2011, with implementation in the first half of 2012. More information about the QUEST RFP and the procurement process can be found on the State Procurement Office website at: http://www.spo.hawaii.gov/procurement-notices.