REPORT TITLE:
Alcohol and Substance Abuse


DESCRIPTION:
Repeals requirement that physicians be certified to treat alcohol
and drug abuse for purposes of mental health insurance benefits
for treatment of drug and alcohol abuse.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                            328         
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO SUBSTANCE ABUSE. 


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

 1      SECTION 1.  The legislature finds that licensed physicians
 
 2 are qualified by education and training to treat alcohol and drug
 
 3 abuse.  The legislature further finds that current law regarding
 
 4 mental health and alcohol and drug abuse treatment insurance
 
 5 benefits unnecessarily restricts the practice of licensed
 
 6 physicians to those with special certification to treat alcohol
 
 7 and drug abuse.  The purpose of this Act to repeal the
 
 8 certification requirement as unnecessary.  
 
 9      SECTION 2.  Section 431M-1, Hawaii Revised Statutes, is
 
10 amended by:
 
11      1.  Amending the definition of "alcohol or drug dependence
 
12 outpatient services" to read:
 
13      ""Alcohol or drug dependence outpatient services" means
 
14 alcohol or drug dependence nonresidential treatment provided on
 
15 an ambulatory basis to patients with alcohol or drug dependence
 
16 problems that includes interventions prescribed and performed by
 
17 [physicians,] psychologists, clinical social workers, or advanced
 
18 practice registered nurses who have been certified pursuant to
 
19 chapter 321[.], or by physicians.  This definition shall not
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1 imply a broadening of the scope of or granting of prescriptive
 
 2 authority privileges, except as otherwise allowed pursuant to
 
 3 chapter 457."
 
 4      2.  Amending the definition of "certified substance abuse
 
 5 staff" to read:
 
 6      ""Certified substance abuse staff" means professionals and
 
 7 paraprofessionals with current full certification as substance
 
 8 abuse counselors or program administrators under chapter 321, and
 
 9 physicians [who hold a current American Society of Addiction
 
10 Medicine certificate.]; provided that physicians shall be exempt
 
11 from certification for purposes of this chapter.
 
12      3.  Amending the definition of "day treatment services" to
 
13 read:
 
14      ""Day treatment services" means treatment services provided
 
15 by a hospital, mental health outpatient facility, or nonhospital
 
16 facility to patients who, because of their conditions, require
 
17 more than periodic hourly service.  Day treatment services shall
 
18 be prescribed by a [physician,] psychologist, clinical social
 
19 worker, [or] advanced practice registered nurse with a
 
20 psychiatric or mental health specialty or subspecialty, or a
 
21 physician, and carried out under the supervision of a
 
22 [physician,] psychologist, clinical social worker, [or] advanced
 
23 practice registered nurse with a psychiatric or mental health
 

 
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                                     H.B. NO.           
                                                        
                                                        

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

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      (2)  An advanced practice registered nurse with a
 
 2           psychiatric or mental health specialty or subspecialty;
 
 3 in consultation with a physician or psychologist.  Partial
 
 4 hospitalization services require less than twenty-four hours of
 
 5 care and a minimum of three hours in any one day."
 
 6      6.  Amending the definition of "treatment episode" to read:
 
 7      ""Treatment episode" means one admission to an accredited
 
 8 hospital or nonhospital facility, or office of a [physician,]
 
 9 psychologist, clinical social worker, [or] advanced practice
 
10 registered nurse certified pursuant to chapter 321 for treatment
 
11 of alcohol or drug dependence, or both, or a physician as
 
12 stipulated in a prescribed treatment plan and which would
 
13 generally produce remission in those who complete the treatment.
 
14 The prescribed treatment plan may include the provision of
 
15 substance abuse services in more than one location and may
 
16 include in-hospital, nonhospital residential, day treatment, or
 
17 alcohol or drug dependence outpatient services, or any
 
18 combination thereof.  An admission for only detoxification
 
19 services shall not constitute a treatment episode."
 
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 5                                         328         
                                     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,
 
 6 [or] advanced practice registered nurse with a psychiatric or
 
 7 mental health specialty or subspecialty, or a physician shall not
 
 8 be less than thirty visits per year to hospital or nonhospital
 
 9 facilities or to mental health outpatient facilities for day
 
10 treatment or partial hospitalization services.  Each day of in-
 
11 hospital services may also be exchanged for two outpatient visits
 
12 under this chapter; provided that the patient's condition is such
 
13 that the outpatient services would reasonably preclude
 
14 hospitalization.  The total covered benefit for outpatient
 
15 services in subsections (b) and (c) shall not be less than
 
16 twenty-four visits per year; provided that coverage of twelve of
 
17 the twenty-four outpatient visits shall apply only to the
 
18 services under subsection (c).  The other covered benefits under
 
19 this chapter shall apply to any of the services in subsection (b)
 
20 or (c).  In the case of alcohol and drug dependence benefits, the
 
21 insurance policy may limit the number of treatment episodes but
 
22 may not limit the number to less than two treatment episodes per
 
23 lifetime.
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 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,]
 

 
Page 7                                         328         
                                     H.B. NO.           
                                                        
                                                        

 
 1           psychologist, clinical social worker, or advanced
 
 2           practice registered nurse certified pursuant to
 
 3           chapter 321, or a physician shall determine that the
 
 4           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, [or]
 
19           advanced practice registered nurse certified pursuant
 
20           to chapter 321, or a physician and must be reasonably
 
21           expected to produce remission of the patient's
 
22           condition.  An individualized treatment plan approved
 
23           by a clinical social worker or an advanced practice
 

 
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                                     H.B. NO.           
                                                        
                                                        

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

 
Page 9                                         328         
                                     H.B. NO.           
                                                        
                                                        

 
 1           services as a covered benefit under this chapter shall
 
 2           be provided in a hospital or a nonhospital residential
 
 3           facility.  The services to be covered shall include
 
 4           those services required for licensure and
 
 5           accreditation, and shall be included as part of the
 
 6           covered in-hospital services as specified in
 
 7           subsection (a);
 
 8      (3)  Mental health partial hospitalization as a covered
 
 9           benefit under this chapter shall be provided by a
 
10           hospital or a mental health outpatient facility.  The
 
11           services to be covered under this paragraph shall
 
12           include those services required for licensure and
 
13           accreditation and shall be included as part of the
 
14           covered in-hospital services as specified in
 
15           subsection (a); and
 
16      (4)  Mental health outpatient services shall be a covered
 
17           benefit under this chapter and shall be included as
 
18           part of the covered outpatient services as specified in
 
19           subsection (a)."
 
20      SECTION 4.  Statutory material to be repealed is bracketed.
 
21 New statutory material is underscored.
 
22      SECTION 5.  This Act shall take effect upon its approval.
 
23 
 
24                           INTRODUCED BY:  _______________________