96            
HOUSE OF REPRESENTATIVES             H.R. NO.              
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                     HOUSE  RESOLUTION
  REQUESTING THE HAWAII PATIENT BILL OF RIGHTS AND
    RESPONSIBILITIES TASK FORCE TO MAKE A THOROUGH STUDY OF
    THE ISSUES RELATING TO THE USE OF THE TERM "MEDICAL
    NECESSITY" TO DETERMINE THE MOST APPROPRIATE DEFINITION OF
    "MEDICAL NECESSITY," OR TO DEVELOP NEW TERMS TO BETTER
    RESOLVE THE ISSUES EXAMINED.



 1        WHEREAS, one of the more hotly-debated health care issues
 2   around the country relates to the the meaning and use of the
 3   term "medical necessity"; and
 4   
 5        WHEREAS, the term "medical necessity" has become what can
 6   be called an "essentially contestable" concept; and
 7   
 8        WHEREAS, competing definitions of "medical necessity" have
 9   evolved, yet there is no universal acceptance of any one
10   definition, consensus in the literature on guidelines, or a
11   national model; and
12   
13        WHEREAS, the labeling of the various definitions of
14   "medical necessity" depends upon one's perspective; and
15   
16        WHEREAS, despite the lack of definition of "medical
17   necessity," there continues to be a need to anchor a variety of
18   clinical decisions on a universally acceptable definition in
19   order to both improve the quality of health care and to better
20   control costs of health care for consumers; now, therefore,
21   
22        BE IT RESOLVED by the House of Representatives of the
23   Twentieth Legislature of the State of Hawaii, Regular Session
24   of 1999, that the Hawaii Patient Bill of Rights and
25   Responsibilities Task Force convened by the Insurance
26   Commissioner under Act 178, Session Laws of Hawaii 1998, under
27   the auspices of the Insurance Commissioner, is requested to
28   make a thorough study of the issues relating to the use of the
29   term "medical necessity" to determine the most appropriate
30   definition of "medical necessity," or to develop new terms to
31   better resolve the issues examined; and
32   
33        BE IT FURTHER RESOLVED that the task force is specifically
34   requested to examine the following issues:
35   
36        (1)  What is, or should be, a "medically necessary"
37             service;
38   

 
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 1        (2)  Who decides, or should have the power to decide, what
 2             service is "medically necessary";
 3   
 4        (3)  Who is, or should be, held accountable when a
 5             question arises about the medical necessity of a
 6             service; and
 7   
 8        (4)  What evidence is, or should be, required in
 9             determining medical necessity;
10   
11   and
12   
13        BE IT FURTHER RESOLVED that the task force is requested to
14   report its findings and recommendations, including any
15   necessary proposed legislation, to the Legislature no later
16   than twenty days prior to the convening of the Regular Session
17   of 2000; and
18   
19        BE IT FURTHER RESOLVED that certified copies of this
20   Resolution be transmitted to the Insurance Commissioner, the
21   Director of Commerce and Consumer Affairs, and the Director of
22   Health.
23   
24   
25   
26                         OFFERED BY:  ____________________________