REPORT TITLE:
Mental Health Parity



DESCRIPTION:
Provides that specified health insurance plans subject to chapter
431M shall not impose conditions and limits on serious mental
illness benefits, if similar conditions or limits are not applied
for other medical or surgical conditions.  Establishes a Hawaii
Mental Health Insurance Task Force to study the financial and
social implications of mandated equal mental illness and
substance abuse insurance coverage in Hawaii, that is to report
to the legislature before the 2001 regular session, and on
certain treatment and utilization guidelines before the 2000
regular session.  (CD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        844
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                H.D. 2
STATE OF HAWAII                                            C.D. 1
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE.



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

 1      SECTION 1.  Section 431M-1, Hawaii Revised Statutes, is
 
 2 amended by adding a new definition, to be appropriately inserted
 
 3 and to read as follows:
 
 4      ""Serious mental illness" means schizophrenia, schizo-
 
 5 affective disorder, and bipolar mood disorder, as defined in the
 
 6 most recent version of the Diagnostic and Statistical Manual of
 
 7 the American Psychiatric Association, which is of sufficient
 
 8 severity to result in substantial interference with the
 
 9 activities of daily living."
 
10      SECTION 2.  Section 431M-4, Hawaii Revised Statutes, is
 
11 amended by amending subsection (a) to read as follows:
 
12      "(a)  The covered benefit under this chapter shall not be
 
13 less than thirty days of in-hospital services per year.  Each day
 
14 of in-hospital services may be exchanged for two days of
 
15 nonhospital residential services, two days of partial
 
16 hospitalization services, or two days of day treatment services.
 
17 Visits to a physician, psychologist, clinical social worker, or
 
18 advanced practice registered nurse with a psychiatric or mental
 
19 health specialty or subspecialty shall not be less than thirty
 

 
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 1 visits per year to hospital or nonhospital facilities or to
 
 2 mental health outpatient facilities for day treatment or partial
 
 3 hospitalization services.  Each day of in-hospital services may
 
 4 also be exchanged for two outpatient visits under this chapter;
 
 5 provided that the patient's condition is such that the outpatient
 
 6 services would reasonably preclude hospitalization.  The total
 
 7 covered benefit for outpatient services in subsections (b) and
 
 8 (c) shall not be less than twenty-four visits per year; provided
 
 9 that coverage of twelve of the twenty-four outpatient visits
 
10 shall apply only to the services under subsection (c).  The other
 
11 covered benefits under this chapter shall apply to any of the
 
12 services in subsection (b) or (c).  In the case of alcohol and
 
13 drug dependence benefits, the insurance policy may limit the
 
14 number of treatment episodes but may not limit the number to less
 
15 than two treatment episodes per lifetime.  Nothing in this
 
16 section shall be construed to limit serious mental illness
 
17 benefits."
 
18      SECTION 3.  Section 431M-5, Hawaii Revised Statutes, is
 
19 amended to read as follows:
 
20      "[[]�431M-5[]]  Nondiscrimination in deductibles, copayment
 
21 plans, and other limitations on payment.(a)  Deductible or
 
22 copayment plans may be applied to benefits paid to or on behalf
 
23 of patients during the course of treatment as described in
 

 
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 1 section 431M-4, but in any case the proportion of deductibles or
 
 2 copayments shall be not greater than those applied to comparable
 
 3 physical illnesses generally requiring a comparable level of care
 
 4 in each policy.
 
 5      (b)  Notwithstanding subsection (a), health maintenance
 
 6 organizations may establish reasonable provisions for enrollee
 
 7 cost-sharing so long as the amount the enrollee is required to
 
 8 pay does not exceed the amount of copayment and deductible
 
 9 customarily required by insurance policies which are subject to
 
10 the provisions of this chapter for this type and level of
 
11 service.  Nothing in this chapter prevents health maintenance
 
12 organizations from establishing durational limits which are
 
13 actuarially equivalent to the benefits required by this chapter.
 
14 Health maintenance organizations may limit the receipt of covered
 
15 services by enrollees to services provided by or upon referral by
 
16 providers associated with the health maintenance organization.
 
17      (c)  A health insurance plan shall not impose rates, terms,
 
18 or conditions including service limits and financial
 
19 requirements, on serious mental illness benefits, if similar
 
20 rates, terms, or conditions are not applied to services for other
 
21 medical or surgical conditions.  This subsection shall not apply
 
22 to individual or group hospital or medical service plan
 
23 contracts, and nonprofit mutual benefit association and health
 

 
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 1 maintenance organization health plan contracts providing coverage
 
 2 to employers with twenty-five or fewer employees, and government
 
 3 employee health benefits plans under chapter 87; and provided
 
 4 further that this subsection shall not apply to QUEST medical
 
 5 plans under the department of human services until July 1, 2002."
 
 6      SECTION 4.  (a)  There is established, within the department
 
 7 of health for administrative purposes only, the Hawaii mental
 
 8 health insurance task force to study the financial and social
 
 9 implications of mandated equal mental health and substance abuse
 
10 insurance coverage in Hawaii.
 
11      (b)  The task force shall be comprised of the following
 
12 twenty-two members:
 
13      (1)  One member of the senate committee on health and human
 
14           services appointed by the president of the senate;
 
15      (2)  One member of the house of representatives committee on
 
16           health appointed by the speaker of the house of
 
17           representatives;
 
18      (3)  One member from each of the following organizations and
 
19           agencies appointed by the governor: 
 
20           (A)  Hawaii Medical Service Association;
 
21           (B)  Kaiser Permanente Medical Care Program;
 
22           (C)  Department of human services;
 
23           (D)  Department of health;
 

 
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 1           (E)  Equal Insurance Coalition;
 
 2           (F)  NAMI, Oahu;
 
 3           (G)  Hawaii Psychological Association;
 
 4           (H)  Chamber of Commerce of Hawaii;
 
 5           (I)  Hawaii Psychiatric Medical Association;
 
 6           (J)  Hawaii Business Health Council;
 
 7           (K)  Hawaii Medical Association;
 
 8           (L)  Mental Health Association of Hawaii;
 
 9           (M)  National Federation of Independent Businesses;
 
10           (N)  Hawaii Nurses' Association; and
 
11           (O)  Hawaii Building and Trades Council;
 
12      (4)  The following members to be appointed by the task
 
13           force:
 
14           (A)  Two members representing mental health consumers;
 
15                and
 
16           (B)  One member representing small business
 
17                organizations in the state;
 
18      (5)  The insurance commissioner; and
 
19      (6)  One member representing the University of Hawaii school
 
20           of public health, with expertise in biomedical
 
21           statistics or economics.
 
22      (c)  The task force shall:
 
23      (1)  Investigate ways to define and quantify unmet mental
 

 
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 1           health and substance abuse needs in the State, and
 
 2           shall analyze possible outcome data collection measures
 
 3           in order to meaningfully measure and describe:
 
 4           (A)  The efficacy of mental health and substance abuse
 
 5                treatment in the State; and
 
 6           (B)  Unmet mental health and substance abuse treatment
 
 7                needs;
 
 8      (2)  Describe mental health and substance abuse coverage in
 
 9           the State, including deductibles, copayments, and
 
10           covered illnesses and conditions;
 
11      (3)  Describe the relative costs of mental illness and
 
12           substance abuse coverage, and other health coverage in
 
13           the State;
 
14      (4)  Describe mental health and substance abuse treatment
 
15           utilization in the State by adults, adolescents, and
 
16           children;
 
17      (5)  Produce an analysis of the needs of individuals who
 
18           have exhausted their mental health or substance abuse
 
19           treatment benefits;
 
20      (6)  Determine the effect of mandated serious mental illness
 
21           benefits parity on mental health and substance abuse
 
22           services consumers, affected health plans, businesses,
 
23           and other concerned parties, including a review of the
 

 
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 1           experience of health plans in providing the coverage,
 
 2           and an assessment of any impact on costs, services
 
 3           provided, and services utilization; and
 
 4      (7)  Develop treatment and utilization guidelines for
 
 5           severe, biologically-based mental illnesses in addition
 
 6           to those covered under this Act, including, but not
 
 7           limited to:
 
 8           (A)  Major depression;
 
 9           (B)  Obsessive compulsive disorders;
 
10           (C)  Severe panic disorders;
 
11           (D)  Autism and pervasive development disorders;
 
12           (E)  Multiple personality disorder (disassociative
 
13                disorder);
 
14           (F)  Brain damage or disfunction as defined by
 
15                neuropsychological testing; and
 
16           (G)  Other severe and disabling mental disorders such
 
17                as severe anorexia, severe attention-
 
18                deficit/hyperactivity disorder, and severe
 
19                dyslexia.
 
20      (d)  The task force shall perform its duties as follows:
 
21      (1)  The task force shall not utilize any moneys from the
 
22           general fund to support its functions.  Members shall
 
23           serve without compensation;
 

 
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 1      (2)  A simple majority of the members of the task force
 
 2           shall constitute a quorum for the transaction of
 
 3           business, and all actions of the task force shall
 
 4           require the affirmative vote of a majority of the
 
 5           members present;
 
 6      (3)  The task force may hold public hearings as frequently
 
 7           as deemed necessary and feasible to receive testimony
 
 8           on issues relative to the task force's investigation;
 
 9           and
 
10      (4)  The task force may invite participants, including the
 
11           auditor or the auditor's representative, as deemed
 
12           necessary to effectuate its purposes.
 
13      (e)  The task force shall submit a report of its findings
 
14 and recommendations to the speaker of the house of
 
15 representatives, the president of the senate, and the governor no
 
16 later than twenty days before the convening of the regular
 
17 session of 2001, and shall be dissolved upon submittal of its
 
18 report.  Provided that the task force shall submit the report of
 
19 its findings and recommendations concerning treatment and
 
20 utilization guidelines as required under subsection (c)(7) of
 
21 this section, to the speaker of the house of representatives, the
 
22 president of the senate, and the governor no later than twenty
 
23 days before the convening of the regular session of 2000.
 

 
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 1      SECTION 5.  Statutory material to be repealed is bracketed.
 
 2 New statutory material is underscored.
 
 3      SECTION 6.  This Act shall take effect on July 1, 1999;
 
 4 provided that insurance, health, or service plan contracts
 
 5 subject to the terms of this Act and issued or renewed after
 
 6 December 31, 1999, shall be amended to be consistent with this
 
 7 Act; and provided that this Act shall be repealed on July 1,
 
 8 2005.