REPORT TITLE:
Mental Health


DESCRIPTION:
Adds marriage and family therapists for purposes of mental health
and alcohol and drug abuse treatment insurance benefits.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                            327         
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO MENTAL HEALTH. 


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

 1      SECTION 1.  Section 431M-1, Hawaii Revised Statutes, is
 
 2 amended by adding a new definition to be appropriately inserted
 
 3 and to read as follows:
 
 4      ""Marriage and family therapist" means a person licensed in
 
 5 the practice of marriage and family therapy pursuant to chapter
 
 6 451J."
 
 7      SECTION 2.  Section 431M-1, Hawaii Revised Statutes, is
 
 8 amended by:
 
 9      1.  Amending the definition of "alcohol or drug dependence
 
10 outpatient services" to read:
 
11      ""Alcohol or drug dependence outpatient services" means
 
12 alcohol or drug dependence nonresidential treatment provided on
 
13 an ambulatory basis to patients with alcohol or drug dependence
 
14 problems that includes interventions prescribed and performed by
 
15 physicians, psychologists, clinical social workers, marriage and
 
16 family therapists, or advanced practice registered nurses who
 
17 have been certified pursuant to chapter 321.  This definition
 
18 shall not imply a broadening of the scope of or granting of
 
19 prescriptive authority privileges, except as otherwise allowed
 

 
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 1 pursuant to chapter 457."
 
 2      2.  Amending the definition of "day treatment services" to
 
 3 read:
 
 4      ""Day treatment services" means treatment services provided
 
 5 by a hospital, mental health outpatient facility, or nonhospital
 
 6 facility to patients who, because of their conditions, require
 
 7 more than periodic hourly service.  Day treatment services shall
 
 8 be prescribed by a physician, psychologist, clinical social
 
 9 worker, marriage and family therapist, or advanced practice
 
10 registered nurse with a psychiatric or mental health specialty or
 
11 subspecialty, and carried out under the supervision of a
 
12 physician, psychologist, clinical social worker, marriage and
 
13 family therapist, or advanced practice registered nurse with a
 
14 psychiatric or mental health specialty or subspecialty.  Day
 
15 treatment services require less than twenty-four hours of care
 
16 and a minimum of three hours in any one day."
 
17      3.  Amending the definition of "mental health outpatient
 
18 services" to read:
 
19      ""Mental health outpatient services" means mental health
 
20 nonresidential treatment provided on an ambulatory basis to
 
21 patients with mental illness that includes interventions
 
22 prescribed and performed by a physician, psychologist, clinical
 
23 social worker, marriage and family therapist, or advanced
 

 
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 1 practice registered nurse with a psychiatric or mental health
 
 2 specialty or subspecialty."
 
 3      4.  Amending the definition of "partial hospitalization
 
 4 services" to read:
 
 5      ""Partial hospitalization services" means treatment
 
 6 services, including in-hospital treatment services or benefits,
 
 7 provided by a hospital or mental health outpatient facility to
 
 8 patients who, because of their conditions, require more than
 
 9 periodic hourly service.  Partial hospitalization services shall
 
10 be prescribed by a physician or psychologist, and may be
 
11 prescribed by a clinical social worker or a marriage and family
 
12 therapist in consultation with a physician or psychologist or an
 
13 advanced practice registered nurse with a psychiatric or mental
 
14 health specialty or subspecialty in consultation with a physician
 
15 or psychologist.  Partial hospitalization services require less
 
16 than twenty-four hours of care and a minimum of three hours in
 
17 any one day."
 
18      5.  Amending the definition of "treatment episode" to read:
 
19      ""Treatment episode" means one admission to an accredited
 
20 hospital or nonhospital facility, or office of a physician,
 
21 psychologist, clinical social worker, marriage and family
 
22 therapist, or advanced practice registered nurse certified
 
23 pursuant to chapter 321 for treatment of alcohol or drug
 

 
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 1 dependence, or both, as stipulated in a prescribed treatment plan
 
 2 and which would generally produce remission in those who complete
 
 3 the treatment.  The prescribed treatment plan may include the
 
 4 provision of substance abuse services in more than one location
 
 5 and may include in-hospital, nonhospital residential, day
 
 6 treatment, or alcohol or drug dependence outpatient services, or
 
 7 any combination thereof.  An admission for only detoxification
 
 8 services shall not constitute a treatment episode."
 
 9      SECTION 3.  Section 431M-3, Hawaii Revised Statutes, is
 
10 amended by amending subsection (a) to read as follows:
 
11      "(a)  Covered benefits for alcohol dependence, drug
 
12 dependence, or mental illness insurance policies, hospital or
 
13 medical service plan contracts, and health maintenance
 
14 organization health plan contracts shall be limited to those
 
15 services certified by the insurance or health care plan carrier's
 
16 physician, psychologist, clinical social worker, marriage and
 
17 family therapist, or advanced practice registered nurse as
 
18 medically or psychologically necessary at the least restrictive
 
19 appropriate level of care."
 
20      SECTION 4.  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
 

 
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 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,
 
 6 marriage and family therapist, or advanced practice registered
 
 7 nurse with a psychiatric or mental health specialty or
 
 8 subspecialty shall not be less than thirty visits per year to
 
 9 hospital or nonhospital facilities or to mental health outpatient
 
10 facilities for day treatment or partial hospitalization services.
 
11 Each day of in-hospital services may also be exchanged for two
 
12 outpatient visits under this chapter; provided that the patient's
 
13 condition is such that the outpatient services would reasonably
 
14 preclude hospitalization.  The total covered benefit for
 
15 outpatient services in subsections (b) and (c) shall not be less
 
16 than twenty-four visits per year; provided that coverage of
 
17 twelve of the twenty-four outpatient visits shall apply only to
 
18 the services under subsection (c).  The other covered benefits
 
19 under this chapter shall apply to any of the services in
 
20 subsection (b) or (c).  In the case of alcohol and drug
 
21 dependence benefits, the insurance policy may limit the number of
 
22 treatment episodes but may not limit the number to less than two
 
23 treatment episodes per lifetime.
 

 
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 1      (b)  Alcohol and drug dependence benefits shall be as
 
 2 follows:
 
 3      (1)  Detoxification services as a covered benefit under this
 
 4           chapter shall be provided either in a hospital or in a
 
 5           nonhospital facility which has a written affiliation
 
 6           agreement with a hospital for emergency, medical, and
 
 7           mental health support services.  The following services
 
 8           shall be covered under detoxification services:
 
 9           (A)  Room and board;
 
10           (B)  Diagnostic x-rays;
 
11           (C)  Laboratory testing; and
 
12           (D)  Drugs, equipment use, special therapies, and
 
13                supplies.
 
14           Detoxification services shall be included as part of
 
15           the covered in-hospital services, but shall not be
 
16           included in the treatment episode limitation, as
 
17           specified in subsection (a);
 
18      (2)  Alcohol or drug dependence treatment through in-
 
19           hospital, nonhospital residential, or day treatment
 
20           substance abuse services as a covered benefit under
 
21           this chapter shall be provided in a hospital or
 
22           nonhospital facility.  Before a person qualifies to
 
23           receive benefits under this subsection, a physician,
 

 
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                                     H.B. NO.           
                                                        
                                                        

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

 
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                                     H.B. NO.           
                                                        
                                                        

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

 
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 1           in consultation with the physician or psychologist;
 
 2      (2)  In-hospital and nonhospital residential mental health
 
 3           services as a covered benefit under this chapter shall
 
 4           be provided in a hospital or a nonhospital residential
 
 5           facility.  The services to be covered shall include
 
 6           those services required for licensure and
 
 7           accreditation, and shall be included as part of the
 
 8           covered in-hospital services as specified in subsection
 
 9           (a);
 
10      (3)  Mental health partial hospitalization as a covered
 
11           benefit under this chapter shall be provided by a
 
12           hospital or a mental health outpatient facility.  The
 
13           services to be covered under this paragraph shall
 
14           include those services required for licensure and
 
15           accreditation and shall be included as part of the
 
16           covered in-hospital services as specified in subsection
 
17           (a); and
 
18      (4)  Mental health outpatient services shall be a covered
 
19           benefit under this chapter and shall be included as
 
20           part of the covered outpatient services as specified in
 
21           subsection (a)."
 
22      SECTION 5.  New statutory material is underscored.
 

 
 
 
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 1      SECTION 6.  This Act shall take effect upon its approval.
 
 2 
 
 3                           INTRODUCED BY:  _______________________