REPORT TITLE:
Mental health parity


DESCRIPTION:
Makes health insurance coverage for mental illness no less
extensive than that for other medical illnesses.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                            320         
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE.



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

 1      SECTION 1.  The legislature finds that treatment costs for
 
 2 mental illnesses are comparable to those for other medical
 
 3 illnesses.  Serious mental illnesses can also be treated as
 
 4 effectively as other medical illnesses.  Although treatment costs
 
 5 and efficacy rates for mental illnesses are comparable to those
 
 6 of other medical illnesses, private sector health insurance
 
 7 coverage for mental illnesses is not comparable for other medical
 
 8 illnesses.  The inadequate treatment of mental illness increases
 
 9 health costs, economic costs, and human costs that are borne by
 
10 patients, families, and the rest of society.  The annual cost to
 
11 the nation in lost productivity stemming from workers struggling
 
12 with the effects of untreated mental disorders is over
 
13 $60,000,000,000.  Because treatment for mental illnesses is
 
14 effective, productivity increases dramatically with treatment.
 
15      The legislature further finds that inequitable insurance
 
16 coverage for mental illness is discriminatory against persons
 
17 with mental illness because other medical conditions which have
 
18 similar or equivalent treatment costs and efficacy rates are
 
19 covered by private sector health insurance policies.
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      The purpose of this Act is to end discrimination in health
 
 2 insurance against persons with mental illness by enacting a
 
 3 parity law that mandates equal insurance coverage for mental
 
 4 illness and all other medical illnesses.
 
 5      SECTION 2.  Section 431M-1, Hawaii Revised Statutes, is
 
 6 amended by adding two new definitions to be appropriately
 
 7 inserted and to read as follows:
 
 8      ""Health insurance plan" means any contract or policy of
 
 9 health insurance delivered or issued for delivery within this
 
10 State to an employer or an individual on a group or individual
 
11 basis.  Health insurance plans include any health benefit plan
 
12 offered or administered privately, by the state, or by any
 
13 subdivision or instrumentality of the State.
 
14      "Rate, term, or condition" means any lifetime or annual
 
15 payment limits, inpatient or outpatient service limits, and
 
16 financial requirements including deductibles, copayments,
 
17 coinsurance and other cost sharing requirements, out-of-pocket
 
18 limits, and other financial components of health insurance
 
19 coverage that affects the insured."
 
20      SECTION 3.  Section 431M-4, Hawaii Revised Statutes, is
 
21 amended to read as follows:
 
22      "431M-4 Mental illness, alcohol and drug dependence
 
23 benefits.(a)  [The covered benefit under this chapter shall not
 

 
Page 3                                         320         
                                     H.B. NO.           
                                                        
                                                        

 
 1 be less than thirty days of in-hospital services per year.  Each
 
 2 day of in-hospital services may be exchanged for two days of
 
 3 nonhospital residential services, two days of partial
 
 4 hospitalization services, or two days of day treatment services.
 
 5 Visits to a physician, psychologist, clinical social worker, or
 
 6 advanced practice registered nurse with a psychiatric or mental
 
 7 health specialty or subspecialty shall not be less than thirty
 
 8 visits per year to hospital or nonhospital facilities or to
 
 9 mental health outpatient facilities for day treatment or partial
 
10 hospitalization services.  Each day of in-hospital services may
 
11 also be exchanged for two outpatient visits under this chapter;
 
12 provided that the patient's condition is such that the outpatient
 
13 services would reasonably preclude hospitalization.  The total
 
14 covered benefit for outpatient services in subsections (b) and
 
15 (c) shall not be less than twenty-four visits per year; provided
 
16 that coverage of twelve of the twenty-four outpatient visits
 
17 shall apply only to the services under subsection (c).]  Subject
 
18 to the provisions of this section, health insurance plans shall
 
19 not impose rates, terms, and conditions, including service limits
 
20 and financial requirements, on the coverage of mental health and
 
21 chemical dependency benefits, if similar rates, terms, and
 
22 conditions are not applied to services for other medical or
 
23 surgical conditions.  The [other] covered benefits under this
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1 chapter shall apply to any of the services in subsection (b)
 
 2 [or], (c)[.  In the case of alcohol and drug dependence benefits,
 
 3 the insurance policy may limit the number of treatment episodes
 
 4 but may not limit the number to less than two treatment episodes
 
 5 per lifetime.], or (d).
 
 6      (b)  Alcohol and drug dependence benefits shall be as
 
 7 follows:
 
 8      (1)  Detoxification services as a covered benefit under this
 
 9           chapter shall be provided either in a hospital or in a
 
10           nonhospital facility which has a written affiliation
 
11           agreement with a hospital for emergency, medical, and
 
12           mental health support services.  The following services
 
13           shall be covered under detoxification services:
 
14           (A)  Room and board;
 
15           (B)  Diagnostic x-rays;
 
16           (C)  Laboratory testing; and
 
17           (D)  Drugs, equipment use, special therapies, and
 
18                supplies.
 
19           Detoxification services shall be included as part of
 
20           the covered in-hospital services, but shall not be
 
21           included in the treatment episode limitation, as
 
22           specified in subsection (a);
 

 
 
 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      (2)  Alcohol or drug dependence treatment through in-
 
 2           hospital, nonhospital residential, or day treatment
 
 3           substance abuse services as a covered benefit under
 
 4           this chapter shall be provided in a hospital or
 
 5           nonhospital facility.  Before a person qualifies to
 
 6           receive benefits under this subsection, a physician,
 
 7           psychologist, clinical social worker, or advanced
 
 8           practice registered nurse certified pursuant to
 
 9           chapter 321 shall determine that the person suffers
 
10           from alcohol or drug dependence, or both.  The
 
11           substance abuse services covered under this paragraph
 
12           shall include those services which are required for
 
13           licensure and accreditation, and shall be included as
 
14           part of the covered in-hospital services as specified
 
15           in subsection (a).  Excluded from alcohol or drug
 
16           dependence treatment under this subsection are
 
17           detoxification services and educational programs to
 
18           which drinking or drugged drivers are referred by the
 
19           judicial system, and services performed by mutual self-
 
20           help groups; and
 
21      (3)  Alcohol or drug dependence outpatient services as a
 
22           covered benefit under this chapter shall be provided
 
23           under an individualized treatment plan approved by a
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           physician, psychologist, clinical social worker, or
 
 2           advanced practice registered nurse certified pursuant
 
 3           to chapter 321 and must be reasonably expected to
 
 4           produce remission of the patient's condition.  An
 
 5           individualized treatment plan approved by a clinical
 
 6           social worker or an advanced practice registered nurse
 
 7           for a patient already under the care or treatment of a
 
 8           physician or psychologist shall be done in consultation
 
 9           with the physician or psychologist.  Services covered
 
10           under this paragraph shall be included as part of the
 
11           covered outpatient services as specified in subsection
 
12           (a).
 
13      (c)  Mental illness benefits.
 
14      (1)  Covered benefits for mental health services set forth
 
15           in this subsection shall be limited to coverage for
 
16           diagnosis and treatment of mental disorders.  All
 
17           mental health services shall be provided under an
 
18           individualized treatment plan approved by a physician,
 
19           psychologist, clinical social worker, or advanced
 
20           practice registered nurse with a psychiatric or mental
 
21           health specialty or subspecialty and must be reasonably
 
22           expected to improve the patient's condition.  An
 
23           individualized treatment plan approved by a clinical
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           social worker or an advanced practice registered nurse
 
 2           with a psychiatric or mental health specialty or
 
 3           subspecialty for a patient already under the care or
 
 4           treatment of a physician or psychologist shall be done
 
 5           in consultation with the physician or psychologist;
 
 6      (2)  In-hospital and nonhospital residential mental health
 
 7           services as a covered benefit under this chapter shall
 
 8           be provided in a hospital or a nonhospital residential
 
 9           facility.  The services to be covered shall include
 
10           those services required for licensure and
 
11           accreditation, and shall be included as part of the
 
12           covered in-hospital services as specified in subsection
 
13           (a);
 
14      (3)  Mental health partial hospitalization as a covered
 
15           benefit under this chapter shall be provided by a
 
16           hospital or a mental health outpatient facility.  The
 
17           services to be covered under this paragraph shall
 
18           include those services required for licensure and
 
19           accreditation and shall be included as part of the
 
20           covered in-hospital services as specified in subsection
 
21           (a); and
 
22      (4)  Mental health outpatient services shall be a covered
 
23           benefit under this chapter and shall be included as
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           part of the covered outpatient services as specified in
 
 2           subsection (a).
 
 3      (d)  The scope and nature of benefits provided under this
 
 4 section shall be required only for expenses arising from
 
 5 treatment of mental health conditions which, in the professional
 
 6 judgment of a practitioner, are medically necessary, and may be
 
 7 delivered under a managed care system."
 
 8      SECTION 4.  Statutory material to be repealed is bracketed.
 
 9 New statutory material is underscored.
 
10      SECTION 5.  This Act shall take effect upon its approval.
 
11 
 
12                           INTRODUCED BY:  _______________________