HB 1285 Summary

• Establishes the Hawaii Self-Insured Health Care System to provide health care to employer-union health benefits trust fund and medicaid beneficiaries through self-insured programs rather than traditional insurance companies.

• Requires the Hawaii Health Authority, employer-union health benefits trust fund, and medicaid division to collaborate on designing consistent self-insured health benefits programs using non-risk administrative services only contracts.

• Grants the Hawaii Health Authority responsibility for determining fees, payment systems, prior authorization policies, formularies, and quality improvement programs while prohibiting delegation of these functions to contractors.

• Prohibits medicaid contracts with managed care organizations and requires a primary care case management model with non-risk administrative services only contracts.

• Prohibits conflicts of interest where entities simultaneously hold administrative authority over health benefits programs and serve as medical services providers; appropriates funds to the Hawaii Health Authority for planning and design of self-insured programs for fiscal years 2021-2022 and 2022-2023.