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THE SENATE                           S.C.R. NO.            S.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                    SENATE  CONCURRENT
                        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 Senate of the Twentieth Legislature
23   of the State of Hawaii, Regular Session of 1999, the House of
24   Representatives concurring, that the Hawaii Patient Bill of
25   Rights and Responsibilities Task Force convened by the
26   Insurance Commissioner under Act 178, Session Laws of Hawaii
27   1998, under the auspices of the Insurance Commissioner, is
28   requested to make a thorough study of the issues relating to
29   the use of the term "medical necessity" to determine the most
30   appropriate definition of "medical necessity," or to develop
31   new terms to better resolve the issues examined; and
32   
33        BE IT FURTHER RESOLVED that the task force is specifically

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