S.C.R. NO.









REQUESTING a study of the social and financial effects of mandating equitable reimbursement under health insurance plans for physicians with a nutrition subspecialty.


WHEREAS, heart disease, cancer, stroke, and diabetes are among the ten leading causes of death in the United States, according to the Centers for Disease Control and Prevention (CDC); and

WHEREAS, in Hawaii, the number of deaths per 100,000 population that occurred in 1999 due to these diseases were 201, 154, 63, and 17, respectively, as reported by the Kaiser Family Foundation (Foundation); and

WHEREAS, the CDCís National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) reports that people who are overweight or obese increase their risk for heart disease, diabetes, some cancers, and high blood pressure, in addition to arthritis-related disabilities; and

WHEREAS, Foundation statistics show that in 2000, Hawaii had an overweight and obesity rate of forty-nine per cent and 47,000 adults were diagnosed with diabetes; and

WHEREAS, according to the NCCDPHP, although chronic diseases, such as heart disease, cancer, and diabetes, are among the most common and costly health problems, they are also among the most preventable; and

WHEREAS, adopting healthy behaviors, including eating nutritious foods, can prevent or control the devastating effects of these diseases; and

WHEREAS, the importance of nutrition in the prevention and control of chronic, life-threatening diseases underscores the importance of medical treatment based on nutritional assessment and intervention, and supports the application of a more equitable fee schedule for physicians who provide these services; and

WHEREAS, a board certified physician in any specialty who has the credentials of a Master's Degree in Nutrition or higher, who uses nutrition as a primary intervention in practice, and who is a consultant to other physicians in such practice should be reimbursed at a rate commensurate with the rate applicable to physicians with other subspecialties such as cardiology and endocrinology; and

WHEREAS, under the fee schedules adopted by health insurers, a preventive medicine specialist with a degree in nutrition is compensated at the same rate as that applicable to a general practitioner with no specialty training; and

WHEREAS, requiring equitable compensation for physicians with a nutrition subspecialty benefits both the health insurance industry and consumers; and

WHEREAS, a more equitable fee schedule may encourage other physicians to undertake the practice of this subspecialty and, thereby, increase the availability of medical professionals trained to address the pathology of disease from a nutritional standpoint; and

WHEREAS, in addition, the increased use of preventative and noninvasive procedures to avoid the onset or progression of disease will help to reduce the need for the use of more invasive, risky, and costly procedures, thereby producing savings in health care costs for insurers and consumers alike; and

WHEREAS, S.B. No. 612 (2004) proposes to require insurers to reimburse physicians with a nutrition subspecialty at a rate commensurate with the reimbursement rate for board certified physician specialists; and

WHEREAS, pursuant to section 23-51, Hawaii Revised Statutes (HRS), before the Legislature may consider a measure that mandates health insurance coverage for specific health services, specific diseases, or services provided by certain health care providers, a concurrent resolution must be passed requesting the Auditor to prepare and submit to the Legislature a report that assesses both the social and financial effects of the proposed mandated coverage; now, therefore,

BE IT RESOLVED by the Senate of the Twenty-Second Legislature of the State of Hawaii, Regular Session of 2004, the House of Representatives concurring, that the Auditor is requested to report to the Legislature on the potential social and financial effects of requiring services provided by a physician with a nutrition subspecialty, as set forth in S.B. No. 612 (2004), to be reimbursed at a rate commensurate with the reimbursement rate for board certified physician specialists; and

BE IT FURTHER RESOLVED that the Auditor is requested to conduct the assessment in accordance with section 23-52, HRS; and

BE IT FURTHER RESOLVED that the Auditor is requested to submit the Auditor's report to the Legislature no later than twenty days before the convening of the 2005 Regular Session; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and the Insurance Commissioner.






Report Title:

Physician w/Nutrition Subspecialty; Insur. Reimb.; Sunrise Study