HI HB1285

Establishes the Hawaii self-insured health care system to provide high-quality health care to employer-union health benefits trust fund (EUTF) and Medicaid beneficiaries through self-insured programs rather than commercial insurance.

Requires the EUTF, Medicaid division of the Department of Human Services, and Hawaii Health Authority to design consistent, closely-aligned self-insured health benefits programs using non-risk administrative services only contracts for claims processing and administrative support.

Prohibits the Department of Human Services from executing Medicaid contracts except through a primary care case management model with non-risk administrative services only contracts, and bars managed care organization contracts for medical services.

Reserves key design authority to the Hawaii Health Authority, EUTF, and Medicaid to determine provider fees, prior authorization policies, formularies, and quality improvement programs rather than delegating these functions to contractors.

Appropriates unspecified funds from the EUTF for fiscal years 2021-2022 and 2022-2023 to the Hawaii Health Authority for planning, designing, and supporting the self-insured health care programs; effective date May 1, 2021.