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 errors
of metabolism.  (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        780
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   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 errors of metabolism; notice.  (a)
 
 6 Public assistance recipients receiving medical assistance
 
 7 pursuant to this chapter shall be allowed coverage for medical
 
 8 foods and low-protein modified food products for the treatment of
 
 9 inborn errors of metabolism for the recipient or dependents of
 
10 the recipient in this State; provided that the medical food or
 
11 low-protein modified food product is:
 
12      (1)  Prescribed as medically necessary for the therapeutic
 
13           treatment of inborn errors of metabolism; and
 
14      (2)  Consumed or administered enterally under the
 
15           supervision of a physician licensed under chapter 453
 
16           or 460.
 
17 Coverage shall be for at least eighty per cent of the cost of the
 
18 medical food or low-protein modified food product prescribed and
 
19 administered pursuant to this subsection.
 

 
Page 2                                                     780
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      The department shall adopt rules pursuant to chapter 91 to
 
 2 effectuate this subsection.
 
 3      (b)  For the purposes of this section:
 
 4      "Inborn error of metabolism" means a disease caused by an
 
 5 inborn abnormality of the body chemistry of a person.
 
 6      "Low-protein modified food product" means a food product
 
 7 that:
 
 8      (1)  Is specially formulated to have less than one gram of
 
 9           protein per serving;
 
10      (2)  Is intended to be used under the direction of a
 
11           physician for the dietary treatment of an inborn error
 
12           of metabolism; and
 
13      (3)  Does not include a food that is naturally low in
 
14           protein.
 
15      "Medical food" means a food that is formulated to be
 
16 consumed or administered enterally under the supervision of a
 
17 physician and that is intended for the specific dietary
 
18 management of a disease or condition for which distinctive
 
19 nutritional requirements, based on recognized scientific
 
20 principles, are established by medical evaluation.
 
21      (c)  All health maintenance organizations and prepaid health
 
22 plans with which the department executes risk contracts for the
 
23 provision of medical care to eligible public assistance
 

 
Page 3                                                     780
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 recipients shall provide notice to its 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      SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended
 
 9 by adding a new section to article 10A to be appropriately
 
10 designated and to read as follows:
 
11      "431:10A-     Medical foods and low-protein modified food
 
12 products; treatment of inborn errors of metabolism; notice.  (a)
 
13 Each policy of accident and sickness insurance issued or renewed
 
14 in this State, each employer group health policy, contract, plan,
 
15 or agreement issued or renewed in this State, all health
 
16 insurance policies issued or renewed in this State, all policies
 
17 providing family coverages as defined in section 431:10A-103, and
 
18 all policies providing reciprocal beneficiary family coverage as
 
19 defined in section 431:10A-601, shall contain a provision for
 
20 coverage for medical foods and low-protein modified food products
 
21 for the treatment of inborn errors of metabolism for its
 
22 policyholders or dependents of the policyholder in this State;
 
23 provided that the medical food or low protein modified food
 

 
Page 4                                                     780
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 product is:
 
 2      (1)  Prescribed as medically necessary for the therapeutic
 
 3           treatment of inborn errors of metabolism; and
 
 4      (2)  Consumed or administered enterally under the
 
 5           supervision of a physician licensed under chapter 453
 
 6           or 460.
 
 7 Coverage shall be for at least eighty per cent of the cost of the
 
 8 medical food or low-protein modified food product prescribed and
 
 9 administered pursuant to this subsection.
 
10      (b)  For the purposes of this section:
 
11      "Inborn error of metabolism" means a disease caused by an
 
12 inborn abnormality of the body chemistry of a person.
 
13      "Low-protein modified food product" means a food product
 
14 that:
 
15      (1)  Is specially formulated to have less than one gram of
 
16           protein per serving;
 
17      (2)  Is intended to be used under the direction of a
 
18           physician for the dietary treatment of an inborn error
 
19           of metabolism; and
 
20      (3)  Does not include a food that is naturally low in
 
21           protein.
 
22      "Medical food" means a food that is formulated to be
 
23 consumed or administered enterally under the supervision of a
 

 
Page 5                                                     780
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 physician and that is intended for the specific dietary
 
 2 management of a disease or condition for which distinctive
 
 3 nutritional requirements, based on recognized scientific
 
 4 principles, are established by medical evaluation.
 
 5      (c)  Every insurer shall provide notice to its policyholders
 
 6 regarding the coverage required by this section.  The notice
 
 7 shall be in writing and prominently placed in any literature or
 
 8 correspondence sent to policyholders and shall be transmitted to
 
 9 policyholders within calendar year 2000 when annual information
 
10 is made available to policyholders, or in any other mailing to
 
11 policyholders, but in no case later than December 31, 2000."
 
12      SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended
 
13 by adding a new section to article 1 to be appropriately
 
14 designated and to read as follows:
 
15      "432:1-     Medical foods and low-protein modified food
 
16 products; treatment of inborn errors of metabolism; notice.  (a)
 
17 All individual and group hospital and medical service plan
 
18 contracts and medical service corporation contracts under this
 
19 chapter shall provide coverage for medical foods and low-protein
 
20 modified food products for the treatment of inborn errors of
 
21 metabolism for its members or dependents of the member in this
 
22 State; provided that the medical food or low-protein modified
 
23 food product is:
 

 
Page 6                                                     780
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      (1)  Prescribed as medically necessary for the therapeutic
 
 2           treatment of inborn errors 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)  For the purposes of this section:
 
10      "Inborn error of metabolism" means a disease caused by an
 
11 inborn abnormality of the body chemistry of a person.
 
12      "Low-protein modified food product" means a food product
 
13 that:
 
14      (1)  Is specially formulated to have less than one gram of
 
15           protein per serving;
 
16      (2)  Is intended to be used under the direction of a
 
17           physician for the dietary treatment of an inborn error
 
18           of metabolism; and
 
19      (3)  Does not include a food that is naturally low in
 
20           protein.
 
21      "Medical food" means a food that is formulated to be
 
22 consumed or administered enterally under the supervision of a
 
23 physician and that is intended for the specific dietary
 

 
Page 7                                                     780
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 management of a disease or condition for which distinctive
 
 2 nutritional requirements, based on recognized scientific
 
 3 principles, are established by medical evaluation.
 
 4      (c)  Every insurer shall provide notice to its members
 
 5 regarding the coverage required by this section.  The notice
 
 6 shall be in writing and prominently placed in any literature or
 
 7 correspondence sent to members and shall be transmitted to
 
 8 members within calendar year 2000 when annual information is made
 
 9 available to members, or in any other mailing to members, but in
 
10 no case later than December 31, 2000."
 
11      SECTION 4.  Section 432D-23, Hawaii Revised Statutes, is
 
12 amended to read as follows:
 
13      "[[]432D-23[]]  Required provisions and benefits.
 
14 Notwithstanding any provision of law to the contrary, each
 
15 policy, contract, plan, or agreement issued in the State after
 
16 January 1, 1995, by health maintenance organizations pursuant to
 
17 this chapter, shall include benefits provided in sections
 
18 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
19 431:10A-116.5, [and] 431:10A-116.6, 431:10A-   , and chapter
 
20 431M."
 
21      SECTION 5.  Statutory material to be repealed is bracketed.
 
22 New statutory material is underscored.
 
23      SECTION 6.  This Act shall take effect upon its approval.