Report Title:

Medicare Advocacy Project; Qualified Nonprofit Organization; Contracted

Description:

Requires the Department of Human Services to contract with a qualified nonprofit organization to identify and assist dually-eligible Medicare and Medicaid recipients to apply for and obtain dual coverage, with payment on a contingency basis. (SD1)

HOUSE OF REPRESENTATIVES

H.B. NO.

1272

TWENTY-SECOND LEGISLATURE, 2003

H.D. 2

STATE OF HAWAII

S.D. 1


 

A BILL FOR AN ACT

 

relating to ADVOCACY FOR human services.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that federal moneys can be a significant source of funding to support Hawaii's health and human services programs but, unfortunately, these federal funds have not been maximized for a variety of reasons, thus causing a direct and unnecessary drain on Hawaii's taxpayers. For example, federal medicare benefits for Hawaii residents who require home health care services or maintenance in a skilled nursing facility have not been maximized.

The legislature further finds that, according to Health Care Financing Administration (known as the Centers for Medicare and Medicaid Services as of July 1, 2001) data for 1997, only five hundred seventy-one per one thousand of Hawaii's elderly medicare beneficiaries received home health care and skilled nursing care, compared to nine hundred seventeen in Montana, nine hundred thirty in Idaho, and nine hundred forty in New Hampshire -- all states with similar populations.

The legislature further finds that in terms of medicare home health care and skilled nursing facility care, Hawaii expended the lowest percentage of federal medicare dollars at only $30,300,000, while Montana expended $64,300,000, Idaho expended $106,000,000, and New Hampshire expended $87,500,000.

The legislature further finds that for fiscal years l996 to 2000, the State of Hawaii reported on its quarterly federal health care financing agency report that its third party liability effort with respect to medicare cost avoidance resulted in $34,630,090, while Montana's third party liability effort resulted in $209,511,516, Idaho's third party liability effort resulted in $409,834,706, and New Hampshire's third party liability effort resulted in $162,599,344.

Therefore, the purpose of this Act is to direct the department of human services to implement a two-year pilot project to maximize Medicare collections and cost avoidance. The goal of this project is to provide the State with a $1,500,000 cost savings through cost avoidance and collection efforts.

SECTION 2. The department of human services shall contract with a qualified nonprofit organization to maximize Medicare collections and cost avoidance by assisting dually-eligible individuals during the application and, if needed, the appeal process, in order to obtain medical coverage under both Medicare and Medicaid; provided that payment to the contractor shall be on a contingency fee basis, where the contractor will be paid one-third of the funds received by the department from the medicare program as a result of this contract. The department shall make available all information required to adequately identify claims for dually-eligible medicare and medicaid recipients.

SECTION 3. This Act shall take effect on July 1, 2003.