THE SENATE

S.B. NO.

2

TWENTY-NINTH LEGISLATURE, 2017

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to homelessness.

 

 

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

 


     SECTION 1.  The purpose of this Act is to ensure that homeless individuals are provided quality health care by requiring insurance coverage for the treatment of homelessness.

     SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

     "§431:10A-    Homelessness; benefits and coverage; homeless individuals.  (a)  Each individual or group accident and health or sickness insurance policy issued or renewed in this State after January 1, 2018, shall provide to the policyholder coverage for the treatment of homelessness.

     (b)  This section shall not apply to disability, accident-only, medicare, medicare supplement, student accident and health or sickness insurance, dental-only, and vision-only policies or policies or renewals of six months or less.

     (c)  Every insurer shall provide written notice to its policyholders regarding the coverage required by this section.  The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year 2018 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2018.

     (d)  Coverage for the treatment of homelessness under this section shall be subject to a maximum benefit of $           per year.  This section shall not be construed as limiting benefits that are otherwise available to an individual under an accident and health or sickness insurance policy.  Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, or service other than treatment of homelessness shall not be applied toward the maximum benefit established under this subsection.

     (e)  Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of an accident and health or sickness insurance policy that are no less favorable than the copayment, deductible, and coinsurance provisions for substantially all medical services covered by the policy.

     (f)  Treatment for homelessness shall include a treatment plan.  Except for inpatient services, if an individual is receiving treatment for homelessness, an insurer may request a review of the treatment plan for continued authorization of coverage for treatment of homelessness at the insurer's discretion.

     (g)  The medical necessity of treatment covered by this section shall be determined pursuant to the policy and shall be defined in the policy in a manner that is consistent with other services under the policy.  Except for inpatient services, if an individual is receiving treatment for homelessness, an insurer may request a review of the medical necessity of that treatment at the insurer's discretion.

     (h)  This section shall not be construed as reducing any obligation to provide services to an individual under any publicly funded program, an individualized family service plan, an individualized education program, or an individualized service plan.

     (i)  As used in this section, unless the context clearly requires otherwise:

     "Homeless individual" has the same meaning as defined in section 334-1.

     "Treatment" of "treatment for homelessness" includes the following care prescribed or ordered for a homeless individual by a licensed physician if the care is determined to be medically necessary:

     (1)  Behavioral health services, including mental health and substance abuse services;

     (2)  Case management;

     (3)  Personal care and personal assistance services; and

     (4)  Home and community-based services."

     SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

     "§432:1-    Homelessness; benefits and coverage; homeless individuals.  (a)  Each hospital and medical service plan contract issued or renewed in this State after January 1, 2018, shall provide to the member covered under the plan contract coverage for the treatment of homelessness.

     (b)  This section shall not apply to disability, accident-only, medicare, medicare supplement, student accident and health or sickness insurance, dental-only, and vision-only policies or policies or renewals of six months or less.

     (c)  Every mutual benefit society shall provide written notice to its members regarding the coverage required by this section.  The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members within calendar year 2018 when annual information is made available to members or in any other mailing to members, but in no case later than December 31, 2018.

     (d)  Coverage for the treatment of homelessness under this section shall be subject to a maximum benefit of $           per year.  This section shall not be construed as limiting benefits that are otherwise available to a member under a hospital and medical service plan contract.  Payments made by an insurer on behalf of a member for any care, treatment, intervention, or service other than treatment of homelessness shall not be applied toward the maximum benefit established under this subsection.

     (e)  Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of policy that are no less favorable than the copayment, deductible, and coinsurance provisions for substantially all medical services covered by the plan contract.

     (f)  Treatment for homelessness shall include a treatment plan.  Except for inpatient services, if an individual is receiving treatment for homelessness, a mutual benefit society may request a review of the treatment plan for continued authorization of coverage for treatment of homelessness at the mutual benefit society's discretion.

     (g)  The medical necessity of treatment covered by this section shall be determined pursuant to the plan contract and shall be defined in the plan contract in a manner that is consistent with other services under the plan contract.  Except for inpatient services, if an individual is receiving treatment for homelessness, a mutual benefit society may request a review of the medical necessity of that treatment at the society's discretion.

     (h)  This section shall not be construed as reducing any obligation to provide services to an individual under any publicly funded program, an individualized family service plan, an individualized education program, or an individualized service plan.

     (i)  As used in this section, unless the context clearly requires otherwise:

     "Homeless individual" has the same meaning as defined in section 334-1.

     "Treatment" or "treatment for homelessness" includes the following care prescribed or ordered for a homeless individual by a licensed physician if the care is determined to be medically necessary:

     (1)  Behavioral health services, including mental health and substance abuse services;

     (2)  Case management;

     (3)  Personal care and personal assistance services; and

     (4)  Home and community-based services."

     SECTION 4.  Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

     "§432D-23  Required provisions and benefits.  Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,] 431:10A-   , and chapter 431M."

     SECTION 5.  The coverage and benefit for the treatment of homelessness to be provided by a health maintenance organization under section 4 of this Act shall apply to all policies, contracts, plans, or agreements issued or renewed in this State by a health maintenance organization after January 1, 2018.

     SECTION 6.  The mandatory coverage and treatment for homelessness required by this Act shall apply to:

     (1)  All health benefits plans under chapter 87A, Hawaii Revised Statutes, issued, renewed, modified, altered, or amended on or after January 1, 2018; and

     (2)  All plans under medicaid managed care programs in the State.

     SECTION 7.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 8.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 9.  This Act shall take effect on July 1, 2017; provided further that paragraph (2) of section 6 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services.

 

INTRODUCED BY:

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Report Title:

Homelessness; Treatment; Mandatory Health Coverage

 

Description:

Beginning January 1, 2018, requires all health plans in the State, including EUTF health plans and medicaid managed care programs, to provide coverage for the treatment of homelessness.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.