HOUSE OF REPRESENTATIVES             H.C.R. NO.170         
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                     HOUSE  CONCURRENT
                        RESOLUTION
REQUESTING THE AUDITOR TO CONDUCT A STUDY OF MANDATORY HEALTH
   INSURANCE COVERAGE FOR MENTAL HEALTH AND SUBSTANCE ABUSE.


 1        WHEREAS, mental illness and substance abuse are widespread
 2   diseases that are often misunderstood by others; and
 3   
 4        WHEREAS, mental illness and substance abuse can be treated
 5   by health care professionals who are trained in these areas;
 6   and
 7   
 8        WHEREAS, recent research shows that various forms of
 9   mental illness and substance abuse are caused by biological
10   factors rather than environmental factors; and
11   
12        WHEREAS, as health issues, consideration should be given
13   to cover the treatment of mental illness and substance abuse by
14   health care insurance plans to the same extent that these plans
15   cover treatment for physical illness; and
16   
17        WHEREAS, ideally, mental health and substance abuse
18   treatment benefits would be determined by medical necessity and
19   standardized criteria for patient placement, admission,
20   discharge, and continuing care criteria, which reflect best
21   practices for mental health and substance abuse treatment, with
22   cost controls achieved as insurers exercise oversight of
23   utilization and the authorization of payment for treatment; and
24   
25        WHEREAS, the Auditor conducted a study in response to
26   House Concurrent Resolution No. 18, H.D. 1, 1997, relating to
27   H.B. No. 427, 1997, entitled "Study of Proposed Mandated
28   Additional Mental Health and Alcohol and Drug Abuse Insurance
29   Benefits," proposing that policy coverages for health insurance
30   (section 431M-4, Hawaii Revised Statutes) be required to
31   include treatment for adults with severe mental illness and for
32   children with a serious emotional disturbance and that the
33   coverage be no less extensive than the coverage provided for
34   any other medical illness;
35   
36        WHEREAS, however, the Auditor did not conduct a study in
37   response to House Concurrent Resolution No. 223, S.D. 1, 1998,
38   which requested an updated and extended study on a similar

 
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 1   subject matter because the volume of legislative requests
 2   exceeded the Auditor's work capacity; and
 3   
 4        WHEREAS, House Concurrent Resolution No. 223, S.D. 1,
 5   1998, was adopted at least in part to afford the Auditor the
 6   chance to overcome the obstacles to a more detailed examination
 7   of the parity issue that the Auditor originally encountered in
 8   its 1997 study, with the inclusion of new available data; and
 9   
10        WHEREAS, the Auditor's 1997 study cites low usage rates
11   (two per cent for Hawaii Medical Service Association and four
12   to five per cent for Kaiser in 1996) for mental health or
13   substance abuse services, or both; and
14   
15        WHEREAS, the 1997 Auditor's study concluded that there is
16   insufficient detail about the exact coverage for the parity law
17   proposed in H.B. No. 427, 1997, to estimate its financial
18   impact; and
19   
20        WHEREAS, H.B. No. 320 and S.B. No. 844, S.D. 2, 1999,
21   provide further details for the Auditor to examine regarding
22   coverage including "any lifetime or annual payment limits,
23   inpatient or outpatient service limits, and financial
24   requirements, including deductibles, copayments, coinsurance,
25   out-of-pocket limits, and other cost sharing requirements, and
26   other financial components of a health insurance plan that
27   affects the insured"; and
28   
29        WHEREAS, section 23-51, Hawaii Revised Statutes, requires
30   that:
31   
32             "Before any  legislative  measure  that mandates
33        health  insurance   coverage   for   specific  health
34        services, specific diseases,  or certain providers of
35        health care services as  part  of individual or group
36        health insurance policies,  can  be considered, there
37        shall be concurrent resolutions passed requesting the
38        auditor to prepare  and  submit  to the legislature a
39        report that assesses  both  the  social and financial
40        effects  of  the  proposed  mandated  coverage.   The
41        concurrent  resolutions  shall  designate  a specific
42        legislative bill that:

 
 
 
 
 
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 1   
 2             (1)  Has been introduced in the legislature; and
 3   
 4             (2)  Includes,   at   a   minimum,   information
 5                  identifying the:
 6   
 7                  (A)  Specific health  service,  disease, or
 8                       provider that would be covered;
 9   
10                  (B)  Extent of the coverage;
11   
12                  (C)  Target groups that would be covered;
13   
14                  (D)  Limits on utilization, if any; and
15   
16                  (E)  Standards of care.";
17   
18   now, therefore,
19   
20        BE IT RESOLVED by the House of Representatives of the
21   Twentieth Legislature of the State of Hawaii, Regular Session
22   of 1999, the Senate concurring, that the Auditor is requested
23   to study the social and financial impacts of enacting a parity
24   law that mandates equal insurance coverage for mental illness
25   and all other medical illnesses in response to H.B. No. 320 and
26   S.B. No. 844, S.D. 2, 1999; and
27   
28        BE IT FURTHER RESOLVED that the Auditor, prior to
29   complying with this Concurrent Resolution, is requested to
30   clarify insufficient details which may prohibit an accurate
31   assessment of social and financial impacts of proposed mandated
32   insurance coverage for mental health and substance abuse; and
33   
34        BE IT FURTHER RESOLVED that data collection and analysis
35   are requested to include the Hawaii Medical Service Association
36   and the Kaiser Permanente Medical Care Program, and the 1998
37   report of the Substance Abuse and Mental Health Services
38   Administration of the United States Department of Health and
39   Human Services, entitled, "The Costs and Effects of Parity for
40   Mental Health and Substance Abuse Insurance Benefits"; and
41   
42        BE IT FURTHER RESOLVED that insurers are requested to
43   separate data according to mental health and substance abuse

 
 
 
 
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 1   utilization, and according to treatment utilization by adults,
 2   adolescents, and children; and
 3   
 4        BE IT FURTHER RESOLVED that data submitted are requested
 5   to include an analysis of those who have exhausted their mental
 6   health or substance abuse treatment benefits, including their
 7   two episodes per lifetime treatment limit for substance abuse;
 8   and
 9   
10        BE IT FURTHER RESOLVED that the Auditor is requested to
11   consult with the Department of Health, the Insurance
12   Commissioner, and with all interested parties, including the
13   Board of Medical Examiners, the Board of Psychology, and
14   representatives of insurance carriers, nonprofit mutual benefit
15   associations, health maintenance organizations, public and
16   private providers, consumers, employers and labor
17   organizations, and state agencies which implement policies
18   under chapter 431M, Hawaii Revised Statutes; and
19   
20        BE IT FURTHER RESOLVED that certified copies of this
21   Concurrent Resolution be transmitted to the Auditor, the
22   Directors of Health and Commerce and Consumer Affairs, and the
23   Insurance Commissioner.
24   
25 
26 
27 
28                         OFFERED BY:  ____________________________