Report Title:

Substance Abuse Parity; Medically Necessary Treatment

 

Description:

Prohibits insurance policies from limiting treatment episodes for drug and alcohol dependence unless treatment is determined to be not medically necessary. Prohibits limitation of lifetime treatment episodes if treatment is determined to be medically necessary.

 

THE SENATE

S.B. NO.

2576

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to alcohol and drug dependence benefits.

 

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

SECTION 1. Section 431M-4, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The covered benefit under this chapter shall not be less than thirty days of in-hospital services per year. Each day of in-hospital services may be exchanged for two days of nonhospital residential services, two days of partial hospitalization services, or two days of day treatment services. Visits to a physician, psychologist, licensed clinical social worker, or advanced practice registered nurse shall not be less than thirty visits per year to hospital or nonhospital facilities or to mental health outpatient facilities for day treatment or partial hospitalization services. Each day of in-hospital services may also be exchanged for two outpatient visits under this chapter; provided that the patient's condition is such that the outpatient services would reasonably preclude hospitalization. The total covered benefit for outpatient services in subsections (b) and (c) shall not be less than twenty-four visits per year; provided that coverage of twelve of the twenty-four outpatient visits shall apply only to the services under subsection (c). The other covered benefits under this chapter shall apply to any of the services in subsection (b) or (c). In the case of alcohol and drug dependence benefits, the insurance policy may limit the number of treatment episodes [but may not] only if treatment is determined to be not medically necessary. The insurance policy may not limit the number [to less than two] of treatment episodes per lifetime[.] if treatment is determined to be medically necessary. Nothing in this section shall be construed to limit serious mental illness benefits."

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 Statutory material to be repealed is bracketed and stricken.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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