Report Title:

Mandated Coverage; Cognitive Rehab; Traumatic Brain Injury

Description:

Requires insurers, hospital and medical services plans, and health maintenance organizations to provide coverage for cognitive rehabilitation therapy for injury as a result of traumatic brain injury to their policyholders, members, and enrollees.

HOUSE OF REPRESENTATIVES

H.B. NO.

2839

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to mandatory health coverage for cognitive rehabilitation.

 

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

SECTION 1. The legislature finds that traumatic brain injury is an insult to the brain, not of degenerative or congenital nature, caused by an external force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. Traumatic brain injury is a leading cause of death and disability among children and young adults. Survivors of traumatic brain injury can lead full lives thanks to lifesaving medical techniques and rehabilitation services. However, survivors face a long rehabilitation process that may not be covered by certain health benefit plans. The purpose of this Act is to require insurers, hospital and medical services plans, and health maintenance organizations to provide coverage for survivors of traumatic brain injury for necessary cognitive therapy, neuropsychological testing or treatment, or community reintegration activities.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431:10A-    Cognitive rehabilitation therapy; notice. (a) Any other law to the contrary notwithstanding, each employer group health policy, contract, plan, or agreement issued or renewed in this State after December 31, 2004, shall provide, not as an employer option, cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological, and psychophysiological testing or treatment, neurofeedback therapy, remediation, and necessary post-acute transition services or community reintegration services as a result of and related to an acquired brain injury for the policyholder and individuals covered under the policy, contract, plan, or agreement.

(b) Coverage required under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, and annual or maximum payment limits applicable to other similar coverage under the policy, contract, plan, or agreement.

(c) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year 2004 when annual information is made available to policyholders, or in any other mailing to policyholders, but in no case later than December 31, 2004."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432-    Cognitive rehabilitation therapy; notice. (a) Any other law to the contrary notwithstanding, each individual and group hospital or medical service plan, policy, contract, or agreement issued or renewed in this State after December 31, 2004, shall provide, not as an employer option, cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological, and psychophysiological testing or treatment, neurofeedback therapy, remediation, and necessary post-acute transition services or community reintegration services as a result of and related to an acquired brain injury for the member and individuals covered under the individual and group hospital or medical service plan, policy, contract, or agreement.

(b) Coverage required under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, and annual or maximum payment limits applicable to other similar coverage under the individual and group hospital or medical service plan, policy, contract, or agreement.

(c) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members within calendar year 2004 when annual information is made available to policyholders, or in any other mailing to members, but in no case later than December 31, 2004."

SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, [and] 431:10A-121, and 431:10A-   , and chapter 431M."

SECTION 5. The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-   , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 4 of this Act, shall take effect for all policies, contracts, plans, or agreements issued in the State after December 31, 2004.

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect upon its approval.

INTRODUCED BY:

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