Honolulu, Hawaii



RE:    S.B. No. 668

       S.D. 2




Honorable Donna Mercado Kim

President of the Senate

Twenty-Seventh State Legislature

Regular Session of 2013

State of Hawaii




     Your Committee on Ways and Means, to which was referred S.B. No. 668, S.D. 1, entitled:




begs leave to report as follows:


     The purpose and intent of this measure is to mandate insurance coverage for treatments for autism spectrum disorders.


More specifically, this measure:


(1)  Requires each individual or group accident and health or sickness insurance policy; hospital or medical service plan policy, contract, or agreement; and health maintenance organization policy, contract, plan, or agreement issued or renewed in the State after December 31, 2013, to cover screening, diagnosis, and treatment for autism spectrum disorders for persons up to age twenty-six;


(2)  Limits required coverage for certain treatments to a maximum annual amount of $50,000 and a maximum lifetime amount of $300,000; and


(3)  Specifies that covered treatments for autism spectrum disorders include behavioral health treatment, applied behavior analysis, pharmacy care, psychiatric care, psychological care, and therapeutic care.


     Your Committee received written comments in support of this measure from Autism Speaks, Hawaii Disability Rights Center, Hawaii Medical Association, Special Education Advisory Council, Council on Developmental Disabilities, and eleven concerned individuals.


     Your Committee received written comments in opposition to this measure from the Department of Human Services and Kaiser Permanente Hawaii.


     Your Committee received written comments on this measure from the Department of Budget and Finance, Department of Health, Department of Commerce and Consumer Affairs, Community Children's Council of Hawaii, and Hawaii Medical Service Association.


     Your Committee finds that recent research indicates that the number of persons diagnosed with an autism spectrum disorder in the United States is growing.  In Hawaii, autism spectrum disorders similarly affect a significant and growing number of young people.  However, many treatments for these disorders are not covered by insurance, and as a result, many children go without certain treatments.  Accordingly, your Committee believes that requiring health insurers in Hawaii to cover treatments for autism spectrum disorders, subject to certain age and benefit limits, will allow more families in Hawaii to access care for their children with autism spectrum disorders.


     Your Committee has amended this measure by:


(1)  Clarifying that the $50,000 annual cap and $300,000 maximum lifetime benefit applies to behavioral health treatments, as opposed to all covered treatments;


(2)  Requiring the Insurance Commissioner to adjust the maximum required benefit annually after December 31, 2015;


(3)  Changing the commencement date of the exemption from including mandated autism spectrum disorder benefits for qualified health plans sold through the Hawaii Health Insurance Exchange from January 1, 2016, to January 1, 2014;


(4)  Clarifying that behavioral health treatments are provided or supervised by a Board-Certified Behavior Analyst or a licensed psychologist with appropriate training;


(5)  Requiring health insurers to include as many Board-Certified Behavior Analysts as licensed psychologists in their approved provider networks for applied behavior analysis;


(6)  Clarifying that the term "autism spectrum disorders" includes any of the pervasive developmental disorders or autism spectrum disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders;


(7)  Clarifying that the individuals diagnosed with an autism spectrum disorder shall not be required to undergo a repeat evaluation upon the publication of subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders to remain eligible for covered benefits;


(8)  Deleting social workers from among the persons who may prescribe or order treatments for autism spectrum disorders;


(9)  Changing the effective date of this measure from January 1, 2030, to July 1, 2050, to encourage further discussion on the measure; and


(10) Making technical nonsubstantive amendments for the purposes of clarity, consistency, and style.


     As affirmed by the record of votes of the members of your Committee on Ways and Means that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 668, S.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 668, S.D. 2.


Respectfully submitted on behalf of the members of the Committee on Ways and Means,