Report Title:

General Assistance; Medical Records; Rebuttable Determination of No Disability; SSI Criteria for Disability Determinations

Description:

Requires review of medical records, prior to claim denial, if no mental, physical, or combination of disability is determined. Makes determination of no disability rebuttable. Requires DHS to give legible prompt notice of treatment recommendations, and gives treating doctors authority to determine whether the person has complied with treatment recommendations. Combines physical and mental disabilities for GA disability determinations.

THE SENATE

S.B. NO.

2228

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to general assistance.

 

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

SECTION 1. Section 346-71, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) A person between eighteen and sixty-five years of age with a disability shall be eligible for general assistance to households without minor dependents if the person:

(1) Is determined to be needy in accordance with standards established by this chapter and the rules adopted under subsection (e);

(2) Is unable to meet the disability requirements established by the federal Supplemental Security Income Program or its successor agency; and

(3) Is unable to engage in any substantial gainful employment because of a determined and certified physical [or], mental, or a combination of physical and mental disability. Determination and certification of [physical and mental] the disability shall be as follows:

(A) A determination and certification of physical disability shall [only] be made by a board of licensed physicians designated and paid by the department. Meetings of this board shall not be subject to part I of chapter 92;

(B) A determination and certification of mental disability shall be made by a board of licensed psychologists or licensed physicians whose specialty is in psychiatry. This board shall also be designated and paid by the department. Meetings of this board shall not be subject to part I of chapter 92;

(C) A determination and certification of a combination of physical disability and mental disability shall be made by the board of licensed physicians under subparagraph (A) in conjunction with the board of licensed psychologists or licensed physicians under subparagraph (B);

(D) If a determination and certification is made that a person does not have a physical, mental, or a combination of a physical and mental disability, prior to a denial of any claim, the board shall consult with the person's treating physician or psychologist, or obtain and review the person's medical records covering at least the six months immediately preceding the determination and certification, or both. The board shall give due consideration to the treating physician's or psychologist's opinion or medical records prior to denying a claim;

[(C)] (E) If a determination of physical, mental, or a combination of a physical or mental disability is made, the person shall accept and pursue appropriate medical treatment from a provider of the person's choice[;]. Whether or not the person has accepted and is pursuing treatment shall be determined by the person's treating physician. The department shall promptly provide the person and the person's personal treating health care provider a complete and legible copy of the department's recommended appropriate treatment;

[(D) If a determination of physical disability is made, the person shall accept and pursue appropriate medical treatment from a provider of the person's choice;]

[(E)] (F) Any person, to continue to be certified as mentally disabled, [or] physically disabled, or both mentally and physically disabled, shall be reevaluated annually, as provided by this section, and more frequently, as required by the department; [and]

[(F)] (G) Failure to pursue appropriate medical treatment shall result in a loss of eligibility, unless the failure is due to good cause. Good cause shall include but not be limited to:

(i) Treatment is unavailable;

(ii) Personal emergencies; and

(iii) Circumstances [which] that threaten the safety of the patient[.]; and

(H) Any determination made pursuant to subparagraph (A), (B), or (C) that a person does not have either a physical, mental, or a combination of a physical and mental disability is rebuttable.

The department shall adopt rules in accordance with chapter 91 to define "good cause", as used in [this] subparagraph[,] G, in order to determine when treatment is unavailable, what constitutes a personal emergency, what circumstances may threaten the safety of a patient, and other factors that may constitute good cause.

As used in this subsection:

"Substantial gainful employment" means at least thirty hours of work per week.

"With a disability" or "having a disability" means a disability that extends for a period of over sixty days.

Any person determined to be eligible under this subsection may be referred to any appropriate state agency for vocational rehabilitation services and shall be required to accept the services as a further condition of eligibility for the receipt of general assistance to households without minor dependents under this section. An assistance unit shall be determined ineligible for general assistance to households without minor dependents if any adult member of the assistance unit fails to cooperate with any appropriate state agency for vocational rehabilitation services after being referred for services. Any person found eligible under this subsection may also be required to seek employment[,] and participate in public work projects, as described in section 346-31, and in public employment projects, as described in section 346-102."

SECTION 2. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 3. This Act shall take effect upon its approval.

INTRODUCED BY:

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