Report Title:

Mental Illness; Major Depression; Health Coverage

Description:

Includes major depression, which involves recurring episodes, in definition of "mental illness" and "serious mental illness." Includes major depression, which may be accompanied by incidence of alcohol or drug dependence, for mental illness coverage.

THE SENATE

S.B. NO.

2085

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to mental health INSURANCE.

 

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

SECTION 1. The legislature finds that major depression is the most severe category of depression. Major depression is manifested by a combination of symptoms that is more intense and severe than mild to moderate depression and that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depression can result from a single traumatic event or may develop slowly as a consequence of numerous personal disappointments and life problems.

Individuals who suffer from major depression can respond to treatment, but some people tend to have recurring major depression, with episodes of depression followed by a period of time without depression, followed by further episodes, usually in response to another trauma.

National statistics also show that in sixty to seventy per cent of cases of major depression, substance abuse also occurs. In Hawaii, statistics show that major depression is a major cause of costly hospital admissions. However, the legislature finds that the cost of treating major depression, which, by definition, includes recurring episodes, can be substantially reduced by treating this disorder via outpatient treatment rather than expensive hospital stays. The purpose of this Act is to include major depression in current mental health treatment insurance coverage, especially when substance abuse is co-ocurring.

SECTION 2. Section 431M-1, Hawaii Revised Statutes, is amended by amending the definitions of "mental illness" and "serious mental illness" to read as follows:

""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[.], and includes major depression, which involves recurring episodes. 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. 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.

"Serious mental illness" means schizophrenia, schizo-affective disorder, bipolar types I and II, as defined in the most recent version of the Diagnostic and Statistical Manual of the American Psychiatric Association, which is of sufficient severity to result in substantial interference with the activities of daily living. Serious mental illness includes major depression, which involves recurring episodes."

SECTION 3. Section 431M-4, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) Mental illness benefits.

(1) Covered benefits for mental health services set forth in this subsection shall be limited to coverage for diagnosis and treatment of mental disorders[.], including recurring episodes of major depression, which may be accompanied by incidence of alcohol or drug dependence, in which case benefits shall extend to treatment of the alcohol or drug dependence. All mental health services shall be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, or advanced practice registered nurse and must be reasonably expected to improve the patient's condition. An individualized treatment plan approved by a licensed clinical social worker or an advanced practice registered nurse for a patient already under the care or treatment of a physician or psychologist shall be done in consultation with the physician or psychologist;

(2) In-hospital and nonhospital residential mental health services as a covered benefit under this chapter shall be provided in a hospital or a nonhospital residential facility. The services to be covered shall include those services required for licensure and accreditation[,] and shall be included as part of the covered in-hospital services as specified in subsection (a);

(3) Mental health partial hospitalization as a covered benefit under this chapter shall be provided by a hospital or a mental health outpatient facility. The services to be covered under this paragraph shall include those services required for licensure and accreditation and shall be included as part of the covered in-hospital services as specified in subsection (a); and

(4) Mental health outpatient services shall be a covered benefit under this chapter and shall be included as part of the covered outpatient services as specified in subsection (a)."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval; provided that section 3 shall take effect on July 1, 2004.

INTRODUCED BY:

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