REPORT TITLE:
Health Insurance


DESCRIPTION:
Requires health insurers to equitably reimburse for mental
health, alcohol, and drug treatment. (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        844
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.  The legislature finds that treatment costs for
 
 2 mental illness are comparable to those for other medical
 
 3 illnesses.  Serious mental illnesses can also be treated as
 
 4 effectively as other medical illnesses.  Although treatment costs
 
 5 and efficacy rates for mental illnesses are comparable to those
 
 6 of other medical illnesses, private sector health insurance
 
 7 coverage for mental illnesses is not comparable to that for other
 
 8 medical illnesses.  The inadequate treatment of mental illness
 
 9 increases health costs, economic costs, and human costs that are
 
10 borne by patients, families, and the rest of society.  The annual
 
11 cost to the nation in lost productivity stemming from workers
 
12 struggling with the effects of untreated mental disorders is over
 
13 $60,000,000,000.  Because treatment for mental illnesses is
 
14 effective, productivity increases dramatically with treatment.
 
15      The legislature further finds that inequitable insurance
 
16 coverage for mental illness is discriminatory against persons
 
17 with mental illness, because other medical conditions which have
 
18 similar or equivalent treatment costs and efficacy rates are
 
19 equitably covered by private sector health insurance policies.  
 

 
Page 2                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      The purpose of this Act is to end discrimination in health
 
 2 insurance against persons with mental illness by enacting a
 
 3 parity law which mandates equitable insurance coverage for mental
 
 4 illness and all other medical illnesses.
 
 5      SECTION 2.  Section 431M-4, Hawaii Revised Statutes, is
 
 6 amended to read as follows:
 
 7      "431M-4 Mental illness, alcohol and drug dependence
 
 8 benefits.(a)  [The covered benefit under this chapter shall not
 
 9 be less than thirty days of in-hospital services per year.  Each
 
10 day of in-hospital services may be exchanged for two days of
 
11 nonhospital residential services, two days of partial
 
12 hospitalization services, or two days of day treatment services.
 
13 Visits to a physician, psychologist, clinical social worker, or
 
14 advanced practice registered nurse with a psychiatric or mental
 
15 health specialty or subspecialty shall not be less than thirty
 
16 visits per year to hospital or nonhospital facilities or to
 
17 mental health outpatient facilities for day treatment or partial
 
18 hospitalization services.  Each day of in-hospital services may
 
19 also be exchanged for two outpatient visits under this chapter;
 
20 provided that the patient's condition is such that the outpatient
 
21 services would reasonably preclude hospitalization.  The total
 
22 covered benefit for outpatient services in subsections (b) and
 
23 (c) shall not be less than twenty-four visits per year; provided
 

 
Page 3                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 that coverage of twelve of the twenty-four outpatient visits
 
 2 shall apply only to the services under subsection (c).]  A health
 
 3 insurance plan shall not impose rates, terms, or conditions,
 
 4 including service limits and financial requirements, on alcohol
 
 5 and drug dependence benefits or mental illness benefits that are
 
 6 not imposed on other covered benefits for health care.  The other
 
 7 covered benefits under this chapter shall apply to any of the
 
 8 services in subsection (b) or (c).  [In the case of alcohol and
 
 9 drug dependence benefits, the insurance policy may limit the
 
10 number of treatment episodes but may not limit the number to less
 
11 than two treatment episodes per lifetime.]
 
12      (b)  Alcohol and drug dependence benefits shall be as
 
13 follows:
 
14      (1)  Detoxification services as a covered benefit under this
 
15           chapter shall be provided either in a hospital or in a
 
16           nonhospital facility which has a written affiliation
 
17           agreement with a hospital for emergency, medical, and
 
18           mental health support services.  The following services
 
19           shall be covered under detoxification services:
 
20           (A)  Room and board;
 
21           (B)  Diagnostic x-rays;
 
22           (C)  Laboratory testing; and
 
23           (D)  Drugs, equipment use, special therapies, and
 

 
Page 4                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1                supplies.
 
 2           Detoxification services shall be included as part of
 
 3           the covered in-hospital services, but shall not be
 
 4           included in the treatment episode limitation, as
 
 5           specified in subsection (a);
 
 6      (2)  Alcohol or drug dependence treatment through in-
 
 7           hospital, nonhospital residential, or day treatment
 
 8           substance abuse services as a covered benefit under
 
 9           this chapter shall be provided in a hospital or
 
10           nonhospital facility.  Before a person qualifies to
 
11           receive benefits under this subsection, a physician,
 
12           psychologist, clinical social worker, or advanced
 
13           practice registered nurse certified pursuant to
 
14           chapter 321 shall determine that the person suffers
 
15           from alcohol or drug dependence, or both.  The
 
16           substance abuse services covered under this paragraph
 
17           shall include those services which are required for
 
18           licensure and accreditation, and shall be included as
 
19           part of the covered in-hospital services as specified
 
20           in subsection (a).  Excluded from alcohol or drug
 
21           dependence treatment under this subsection are
 
22           detoxification services and educational programs to
 
23           which drinking or drugged drivers are referred by the
 

 
Page 5                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           judicial system, and services performed by mutual self-
 
 2           help groups; and
 
 3      (3)  Alcohol or drug dependence outpatient services as a
 
 4           covered benefit under this chapter shall be provided
 
 5           under an individualized treatment plan approved by a
 
 6           physician, psychologist, clinical social worker, or
 
 7           advanced practice registered nurse certified pursuant
 
 8           to chapter 321 and must be reasonably expected to
 
 9           produce remission of the patient's condition.  An
 
10           individualized treatment plan approved by a clinical
 
11           social worker or an advanced practice registered nurse
 
12           for a patient already under the care or treatment of a
 
13           physician or psychologist shall be done in consultation
 
14           with the physician or psychologist.  Services covered
 
15           under this paragraph shall be included as part of the
 
16           covered outpatient services as specified in subsection
 
17           (a).
 
18      (c)  Mental illness benefits.
 
19      (1)  Covered benefits for mental health services set forth
 
20           in this subsection shall be limited to coverage for
 
21           diagnosis and treatment of mental disorders.  All
 
22           mental health services shall be provided under an
 
23           individualized treatment plan approved by a physician,
 

 
Page 6                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           psychologist, clinical social worker, or advanced
 
 2           practice registered nurse with a psychiatric or mental
 
 3           health specialty or subspecialty and must be reasonably
 
 4           expected to improve the patient's condition.  An
 
 5           individualized treatment plan approved by a clinical
 
 6           social worker or an advanced practice registered nurse
 
 7           with a psychiatric or mental health specialty or
 
 8           subspecialty for a patient already under the care or
 
 9           treatment of a physician or psychologist shall be done
 
10           in consultation with the physician or psychologist;
 
11      (2)  In-hospital and nonhospital residential mental health
 
12           services as a covered benefit under this chapter shall
 
13           be provided in a hospital or a nonhospital residential
 
14           facility.  The services to be covered shall include
 
15           those services required for licensure and
 
16           accreditation, and shall be included as part of the
 
17           covered in-hospital services as specified in subsection
 
18           (a);
 
19      (3)  Mental health partial hospitalization as a covered
 
20           benefit under this chapter shall be provided by a
 
21           hospital or a mental health outpatient facility.  The
 
22           services to be covered under this paragraph shall
 
23           include those services required for licensure and
 

 
Page 7                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           accreditation and shall be included as part of the
 
 2           covered in-hospital services as specified in subsection
 
 3           (a); and
 
 4      (4)  Mental health outpatient services shall be a covered
 
 5           benefit under this chapter and shall be included as
 
 6           part of the covered outpatient services as specified in
 
 7           subsection (a).
 
 8      (d)  The benefits under subsections (b) and (c) shall be
 
 9 covered only if the services are medically necessary, as
 
10 determined by the professional judgment of a physician.
 
11      (e)  As used in this section:
 
12      "Health insurance plan" means any contract or policy of
 
13 health insurance issued to an employer on a group basis or to an
 
14 individual on an individual basis, as applicable, including any
 
15 health insurance plan covering public employees, or covering
 
16 persons receiving public assistance benefits or persons
 
17 qualifying under other medical insurance programs of the
 
18 department of human services.
 
19      "Rate, term, or condition" means any lifetime or annual
 
20 payment limits, inpatient or outpatient service limits, and
 
21 financial requirements, including deductibles, copayments,
 
22 coinsurance, out-of-pocket limits, and other cost sharing
 
23 requirements, and other financial components of a health
 
24 insurance plan that affects the insured."
 

 
Page 8                                                     844
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      SECTION 3.  Statutory material to be repealed is bracketed.
 
 2 New statutory material is underscored.
 
 3      SECTION 4.  This Act shall take effect upon its approval.