Mental Health Parity
Prohibits any rate, term, or condition that places a greater financial burden on an insured for access to treatment for mental illness than for access to treatment for a physical health condition. Requires insurance commissioner to report on effects of prohibition by 1/15/2005.
TWENTY-SECOND LEGISLATURE, 2004
STATE OF HAWAII
A BILL FOR AN ACT
relating to mental health and alcohol and drug abuse insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Section 431M-1, Hawaii Revised Statutes, is amended as follows:
1. By adding a new definition of "rate, term, or condition" to read:
""Rate, term, or condition" means any lifetime or annual payment limits, deductibles, co-payments, coinsurance and any other cost-sharing requirements, out-of-pocket limits, visit limits, and any other financial component of health insurance coverage that affects the insured."
2. By amending the definition of "mental illness" to read:
""Mental illness" means a syndrome of clinically significant psychological, biological, or behavioral abnormalities that results in personal distress or suffering, impairment of capacity for functioning, or both. For the purposes of this chapter, the terms "mental disorder" and "mental illness" shall be used interchangeably and shall include the definitions identified in the most recent publications of the Diagnostic and Statistical Manual of the American Psychiatric Association or International Classification of Disease. Mental illness also includes alcohol or drug abuse and dependence. Epilepsy, senility, mental retardation, or other developmental disabilities [
and addiction to or abuse of intoxicating substances] do not in and of themselves constitute a mental disorder."
SECTION 2. Section 431M-2, Hawaii Revised Statutes, is amended to read as follows:
"§431M-2 Policy coverage[
.]; nondiscrimination; rules. (a) All individual and group accident and health or sickness insurance policies issued in this State, individual or group hospital or medical service plan contracts, and nonprofit mutual benefit association and health maintenance organization health plan contracts shall include within their hospital and medical coverage the benefits of alcohol dependence, drug dependence, and mental illness treatment services provided in section 431M-4; except that this section shall not apply to insurance policies that are issued solely for single diseases[ ,] or otherwise limited, specialized coverage.
(b) Any policy issued under subsection (a) shall provide coverage for treatment of mental illness and shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for mental illness than for access to treatment for a physical health condition. Any deductible or out-of-pocket limits required under a policy issued under subsection (a) shall be as comprehensive for coverage of mental illness as it is for physical health conditions.
(c) Any policy issued under subsection (a) that does not otherwise provide for management of care under the plan, or that does not provide for the same degree of management of care for all health conditions, may provide coverage for treatment of mental illness through a managed care organization provided that the managed care organization is in compliance with the rules adopted by the commissioner that ensure that the system for delivery of treatment for mental illness does not diminish or negate the purpose of this section. The rules adopted by the commissioner shall ensure that:
(1) Timely and appropriate access to care is available;
(2) The quantity, location, and specialty distribution of health care providers is adequate; and
(3) Administrative or clinical protocols do not serve to reduce access to medically necessary treatment for any insured.
(d) Any policy issued under subsection (a) shall be construed to be in compliance with this section if at least one choice for treatment of mental illness provided to the insured within the plan has rates, terms, and conditions that place no greater financial burden on the insured than for access to treatment of physical conditions. The commissioner may disapprove any plan that the commissioner determines to be inconsistent with the purposes of this section.
(e) To be eligible for coverage under this section, the service shall be rendered:
(1) For treatment of mental illness:
(A) By a licensed or certified mental health professional; or
(B) In a mental health outpatient facility that provides a program for the treatment of mental illness pursuant to a written plan.
(2) For treatment of alcohol or drug dependence:
(A) By a substance abuse counselor; or
(B) In an institution that provides a program for the treatment of alcohol or drug dependence pursuant to a written plan.
(f) The commissioner shall adopt rules pursuant to chapter 91 to implement this section."
SECTION 3. Report. Not later than January 15, 2005, the insurance commissioner shall report to the legislature and the governor on the following:
(1) An estimate of the impact of this Act on health insurance costs;
(2) Actions taken by the insurance commissioner to ensure that policies issued under section 431M-2, Hawaii Revised Statutes, are in compliance with this Act and that quality and access to treatment for mental illness provided by the plans are not compromised by providing financial parity for such coverage;
(3) When a policy issued under section 431M-2, Hawaii Revised Statutes, offers choices for treatment of mental illness and alcohol and drug dependence, an analysis and comparison of those choices in regard to level of access, choice, and financial burden; and
(4) Identification of any segments of the population of Hawaii that may be excluded from access to treatment for mental illness and alcohol and drug abuse dependence at the level provided by this Act, including an estimate of the number of residents excluded from such access under health benefit plans offered or administered by employers who receive the majority of their annual revenues from contract, grants, or other expenditures by state agencies.
SECTION 4. Construction; transition rules. (a) This Act shall not be construed to:
(1) Limit the provision of specialized medicaid covered services for individuals with mental illness or alcohol or drug dependence disorders;
(2) Contravene the provisions of federal law, federal or state medicaid policy, or the terms and conditions imposed on any medicaid waiver granted to the State with respect to the provision of services to individuals with mental illness or alcohol or drug dependence disorders; and
(3) Affect any annual health insurance policy issued under section 431M-2, Hawaii Revised Statutes, until its date of renewal or any health insurance plan governed by a collective bargaining agreement or employment contract until the expiration of that contract.
(b) Any rules relating to eligibility for payment for treatment of mental illness and alcoholism or drug dependence shall remain in effect until the effective date of this Act and thereafter shall be deemed to be the rules adopted by the insurance commissioner under section 431M-2, Hawaii Revised Statutes, to the extent that they are consistent with this Act and until amended or repealed by the insurance commissioner.
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect upon its approval.