REPORT TITLE:
Mandatory Medical Foods Coverage


DESCRIPTION:
Requires health insurance coverage for medical foods and low-
protein modified food products for the treatment of inborn error
of metabolism.  (HB326 CD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        326
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 1999                                S.D. 1
STATE OF HAWAII                                            C.D. 1
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE.



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

 1      SECTION 1.  Chapter 346, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to be appropriately designated and to
 
 3 read as follows:
 
 4      "346-    Medical foods and low-protein modified food
 
 5 products; treatment of inborn error of metabolism; notice.  (a)
 
 6 Public assistance recipients in this State who receive medical
 
 7 assistance pursuant to this chapter shall be allowed coverage for
 
 8 medical foods and low-protein modified food products for the
 
 9 treatment of an inborn error of metabolism; provided that the
 
10 medical food or low-protein modified food product is:
 
11      (1)  Prescribed as medically necessary for the therapeutic
 
12           treatment of an inborn error of metabolism; and
 
13      (2)  Consumed or administered enterally under the
 
14           supervision of a physician licensed under chapter 453
 
15           or 460.
 
16      The department shall adopt rules pursuant to chapter 91 to
 
17 effectuate this subsection.
 
18      (b)  All health maintenance organizations and prepaid health
 
19 plans with which the department executes risk contracts for the
 
20 provision of medical care to eligible public assistance
 

 
Page 2                                                     326
                                     H.B. NO.           H.D. 1
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 1 recipients shall provide notice to their members regarding the
 
 2 coverage required by this section.  The notice shall be in
 
 3 writing and prominently placed in any literature or
 
 4 correspondence sent to members and shall be transmitted to
 
 5 members within calendar year 2000 when annual information is made
 
 6 available to members, or in any other mailing to members, but in
 
 7 no case later than December 31, 2000.
 
 8      (c)  For the purposes of this section:
 
 9      "Inborn error of metabolism" means a disease caused by an
 
10 inherited abnormality of the body chemistry of a person that is
 
11 characterized by deficient metabolism, originating from
 
12 congenital defects or defects arising shortly after birth, of
 
13 amino acid, organic acid, carbohydrate, or fat.
 
14      "Low protein modified food product" means a food product
 
15 that:
 
16      (1)  Is specially formulated to have less than one gram of
 
17           protein per serving;
 
18      (2)  Is prescribed or ordered by a physician as medically
 
19           necessary for the dietary treatment of an inborn error
 
20           of metabolism; and
 
21      (3)  Does not include a food that is naturally low in
 
22           protein.
 

 
 
 
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                                     H.B. NO.           H.D. 1
                                                        S.D. 1
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 1      "Medical food" means a food that is formulated to be
 
 2 consumed or administered enterally under the supervision of a
 
 3 physician and is intended for the specific dietary management of
 
 4 a disease or condition for which distinctive nutritional
 
 5 requirements, based on recognized scientific principles, are
 
 6 established by medical evaluation."
 
 7      SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended
 
 8 by adding a new section to article 10A to be appropriately
 
 9 designated and to read as follows:
 
10      "431:10A-     Medical foods and low-protein modified food
 
11 products; treatment of inborn error of metabolism; notice.  (a)
 
12 Each policy of accident and sickness insurance, other than life
 
13 insurance, disability income insurance, and long-term care
 
14 insurance, issued or renewed in this State, each employer group
 
15 health policy, contract, plan, or agreement issued or renewed in
 
16 this State, all health insurance policies issued or renewed in
 
17 this State, all policies providing family coverages as defined in
 
18 section 431:10A-103, and all policies providing reciprocal
 
19 beneficiary family coverage as defined in section 431:10A-601,
 
20 shall contain a provision for coverage for medical foods and low-
 
21 protein modified food products for the treatment of an inborn
 
22 error of metabolism for its policyholders or dependents of the
 
23 policyholder in this State; provided that the medical food or low
 
24 protein modified food product is:
 

 
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                                     H.B. NO.           H.D. 1
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 1      (1)  Prescribed as medically necessary for the therapeutic
 
 2           treatment of an inborn error of metabolism; and
 
 3      (2)  Consumed or administered enterally under the
 
 4           supervision of a physician licensed under chapter 453
 
 5           or 460.
 
 6 Coverage shall be for at least eighty per cent of the cost of the
 
 7 medical food or low-protein modified food product prescribed and
 
 8 administered pursuant to this subsection.
 
 9      (b)  Every insurer shall provide notice to its policyholders
 
10 regarding the coverage required by this section.  The notice
 
11 shall be in writing and prominently placed in any literature or
 
12 correspondence sent to policyholders and shall be transmitted to
 
13 policyholders during calendar year 2000 when annual information
 
14 is made available to policyholders, or in any other mailing to
 
15 policyholders, but in no case later than December 31, 2000.
 
16      (c)  For the purposes of this section:
 
17      "Inborn error of metabolism" means a disease caused by an
 
18 inherited abnormality of the body chemistry of a person that is
 
19 characterized by deficient metabolism, originating from
 
20 congenital defects or defects arising shortly after birth, of
 
21 amino acid, organic acid, carbohydrate, or fat.
 
22      "Low-protein modified food product" means a food product
 
23 that:
 

 
Page 5                                                     326
                                     H.B. NO.           H.D. 1
                                                        S.D. 1
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 1      (1)  Is specially formulated to have less than one gram of
 
 2           protein per serving;
 
 3      (2)  Is prescribed or ordered by a physician as medically
 
 4           necessary for the dietary treatment of an inborn error
 
 5           of metabolism; and
 
 6      (3)  Does not include a food that is naturally low in
 
 7           protein.
 
 8      "Medical food" means a food that is formulated to be
 
 9 consumed or administered enterally under the supervision of a
 
10 physician and is intended for the specific dietary management of
 
11 a disease or condition for which distinctive nutritional
 
12 requirements, based on recognized scientific principles, are
 
13 established by medical evaluation."
 
14      SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended
 
15 by adding a new section to article 1 to be appropriately
 
16 designated and to read as follows:
 
17      "432:1-     Medical foods and low-protein modified food
 
18 products; treatment of inborn error of metabolism; notice.  (a)
 
19 All individual and group hospital and medical service plan
 
20 contracts and medical service corporation contracts under this
 
21 chapter shall provide coverage for medical foods and low-protein
 
22 modified food products for the treatment of an inborn error of
 

 
 
 
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                                     H.B. NO.           H.D. 1
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 1 metabolism for its members or dependents of the member in this
 
 2 State; provided that the medical food or low-protein modified
 
 3 food product is:
 
 4      (1)  Prescribed as medically necessary for the therapeutic
 
 5           treatment of an inborn error of metabolism; and
 
 6      (2)  Consumed or administered enterally under the
 
 7           supervision of a physician licensed under chapter 453
 
 8           or 460.
 
 9 Coverage shall be for at least eighty per cent of the cost of the
 
10 medical food or low-protein modified food product prescribed and
 
11 administered pursuant to this subsection.
 
12      (b)  Every mutual benefit society shall provide notice to
 
13 its members regarding the coverage required by this section.  The
 
14 notice shall be in writing and prominently placed in any
 
15 literature or correspondence sent to members and shall be
 
16 transmitted to members during calendar year 2000 when annual
 
17 information is made available to members, or in any other mailing
 
18 to members, but in no case later than December 31, 2000.
 
19      (c)  For the purposes of this section:
 
20      "Inborn error of metabolism" means a disease caused by an
 
21 inherited abnormality of the body chemistry of a person that is
 
22 characterized by deficient metabolism, originating from
 
23 congenital defects or defects arising shortly after birth, of
 
24 amino acid, organic acid, carbohydrate, or fat.
 

 
Page 7                                                     326
                                     H.B. NO.           H.D. 1
                                                        S.D. 1
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 1      "Low-protein modified food product" means a food product
 
 2 that:
 
 3      (1)  Is specially formulated to have less than one gram of
 
 4           protein per serving;
 
 5      (2)  Is prescribed or ordered by a physician as medically
 
 6           necessary for the dietary treatment of an inherited
 
 7           metabolic disease; and
 
 8      (3)  Does not include a food that is naturally low in
 
 9           protein.
 
10      "Medical food" means a food that is formulated to be
 
11 consumed or administered enterally under the supervision of a
 
12 physician and is intended for the specific dietary management of
 
13 a disease or condition for which distinctive nutritional
 
14 requirements, based on recognized scientific principles, are
 
15 established by medical evaluation."
 
16      SECTION 4.  Chapter 432D-23, Hawaii Revised Statutes, is
 
17 amended to read as follows:
 
18      "[[]432D-23[]]  Required provisions and benefits.
 
19 Notwithstanding any provision of law to the contrary, each
 
20 policy, contract, plan, or agreement issued in the State after
 
21 January 1, 1995, by health maintenance organizations pursuant to
 
22 this chapter, shall include benefits provided in sections
 

 
 
 
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 1 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
 2 431:10A-116.5, [and] 431:10A-116.6, 431:10A-   , and chapter
 
 3 431M."
 
 4      SECTION 5.  Statutory material to be repealed is bracketed.
 
 5 New statutory material is underscored.
 
 6      SECTION 6.  This Act shall take effect upon its approval.