Report Title:

Medicaid; Psychotropic, HIV/AIDS, Hepatitis C, Immunosuppressive

Description:

Prohibits DHS from restricting Medicaid recipient's access to psychotropic medication and establishes presumptive eligibility in emergency. Exempts prescriptions for psychotropic, HIV/AIDS, and Hepatitis C medications, and transplant immunosuppresives from preauthorization requirement. (SD2)

HOUSE OF REPRESENTATIVES

H.B. NO.

1051

TWENTY-THIRD LEGISLATURE, 2005

H.D. 2

STATE OF HAWAII

S.D. 2


 

A BILL FOR AN ACT

 

relating to prescription drugs.

 

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

PART I

SECTION 1. Chapter 346, Hawaii Revised Statutes, is amended by adding three new sections to be appropriately designated and to read as follows:

"§346-   Psychotropic medication. (a) The department shall not impose any restriction or limitation on the payment for or a recipient's access to psychotropic medication; provided that the psychotropic medication shall be prescribed by a licensed medical care provider pursuant to the laws of this State.

(b) As used in this section, the term "psychotropic medication" means only those agents related to the diagnosis and treatment of mental or emotional disorders, including controlled substances, and the term "licensed medical care provider" means any medical professional licensed in Hawaii to prescribe psychotropic medications.

§346-   Presumptive eligibility for medical assistance; individuals in need of emergency psychiatric or psychological service. (a) An individual who is in need of emergency psychiatric or psychological service and who has not received an eligibility decision from the department shall be presumed eligible for psychotropic medication until an eligibility decision is made; provided that the psychotropic medication shall be prescribed by a licensed medical care provider pursuant to the laws of this State. The department shall reimburse any costs associated with the medication and concomitant physician services during the presumptive eligibility period.

(b) As used in this section, the term "psychotropic medication" means only those agents related to the diagnosis and treatment of mental or emotional disorders, including controlled substances, and the term "licensed medical care provider" means any medical professional licensed in Hawaii to prescribe psychotropic medications.

§346-   Pre-authorization exemption for psychotropic medication. (a) A licensed medical care provider may prescribe psychotropic medication pursuant to the laws of this State for an individual who is medicaid eligible or who is presumed to be medicaid eligible without the requirement of any preauthorization procedure otherwise required by any other provision of this chapter; provided that the individual is in need of emergency psychiatric or psychological service.

(b) As used in this section, the term "psychotropic medication" means only those agents related to the diagnosis and treatment of mental or emotional disorders, including controlled substances, and the term "licensed medical care provider" means any medical professional licensed in Hawaii to prescribe psychotropic medications."

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $          , or so much thereof as may be necessary for fiscal year 2005-2006, and the same sum, or so much thereof as may be necessary for fiscal year 2006-2007, to provide unrestricted payment for and access to psychotropic medication for recipients under chapter 346, Hawaii Revised Statutes.

SECTION 3. The sums appropriated shall be expended by the department of human services for the purposes of this Act.

PART II

SECTION 4. Chapter 346, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part    . MEDICAID PREAUTHORIZATION EXEMPTION

§346-   Findings. The legislature finds that:

(1) Patients who are medicaid recipients and who suffer from the human immunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, or who are in need of immunosuppressives as a result of organ transplants, have the least means available to obtain proper medications required to control their illnesses;

(2) These medicaid recipients, if not promptly treated and maintained on effective medications, will, by the very nature of their illnesses, suffer greatly and may require increased medical care, including prolonged hospitalization, resulting in increased costs to these patients and society as a whole;

(3) Failure to promptly treat a patient with the human immunodeficiency virus, acquired immune deficiency syndrome, or hepatitis C, and failure to use effective immunosuppressives during and after organ transplants, may result in increased suffering by the patients, the early or unnecessary loss of the patients' lives, increased cost of medical care, and increased emotional, physical, financial, and societal costs;

(4) It is ethically imperative that the physicians who treat medicaid recipient patients with human immunodeficiency virus, acquired immune deficiency syndrome, or hepatitis C, or patients who are in need of immunosuppressives before, during, and after transplant operations, have the unfettered ability to promptly medically intervene in treating these patients and to continue proven medications for those patients;

(5) The procedure of requiring preauthorization of medicaid recipients before dispensing medications for the treatment of human immunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, and immunosuppressives needed for transplant patients, is unduly arduous, difficult, and too time-consuming for practitioners with large numbers of these patients who require immediate treatment to avoid permanent injury and other undesirable consequences; and

(6) The imposition of a "first fail" plan before a physician can adjust or change a medication not on the approved list of medications is medically unsound. The condition of a seriously ill patient suffering from the human immunodeficiency virus, acquired immune deficiency syndrome, or hepatitis C, or who is in need of transplant immunosuppressives, will generally not remain stable for long without prompt treatment. If these persons are not more promptly and effectively treated, a significant probability exists that there will be a substantial increase in health care costs and hospitalizations, thereby increasing medical costs to the State.

§346-   Preauthorization exemption for certain physicians. Any physician licensed in this State who treats a medicaid recipient patient suffering from the human immunodeficiency virus, acquired immune deficiency syndrome, or hepatitis C, or who is a patient in need of transplant immunosuppressives, may prescribe any medications approved by the United States Food and Drug Administration that are necessary to treat the patient, without having to comply with the requirements of any preauthorization procedure established by any other provision of this chapter."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 2099.