REPORT TITLE: 
Mental Health


DESCRIPTION:
Clarifies deposit of assessment with the Insurance Commissioner
for health insurers; requires health insurance policies to cover
diabetes self-management training, education, equipment, and
supplies; transfers Hawaii mental health task force from DOH to
insurance division and revises composition of membership.  (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2392
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 2000                                S.D. 1
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                     A BILL FOR AN ACT

RELATING TO HEALTH.


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

 1                              PART I.
 
 2      SECTION 1.  Section 431:2-216, Hawaii Revised Statutes, is
 
 3 amended by amending subsection (a) to read as follows:
 
 4      "(a)  Beginning with fiscal year 2000-2001, and including
 
 5 fiscal year 2001-2002, each mutual benefit society under article
 
 6 1 of chapter 432, health maintenance organization under chapter
 
 7 432D, and any other entity offering or providing health benefits
 
 8 or services under the regulation of the commissioner, except an
 
 9 insurer licensed to offer health insurance under article 10A,
 
10 shall deposit with the commissioner by July 1 of each year an
 
11 assessment of $10,000 for the first zero to seventy thousand
 
12 private, nongovernment members the entity covers and an
 
13 additional assessment on a pro rata basis to be determined and
 
14 imposed by the commissioner for covered members exceeding seventy
 
15 thousand; provided that in the third year and each year
 
16 thereafter, assessments shall be borne on a pro rata basis.  The
 
17 aggregate annual assessment shall not exceed $1,000,000.  The
 
18 assessment shall be credited to the insurance regulation fund.
 
19 If assessments are increased, the commissioner shall provide to
 
20 any organization or entity subject to the increased assessment,
 

 
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 1 justification for the increase."
 
 2                             PART II.
 
 3      SECTION 2.  The legislature finds that approximately ninety
 
 4 thousand people living in Hawaii have diabetes.  Native Hawaiians
 
 5 and Asians experience a risk of developing diabetes that is twice
 
 6 that of the general U.S. population.  Native Hawaiians, compared
 
 7 to all other racial groups in the State during the years 1989
 
 8 through 1991, had the highest rate of mortality due to diabetes
 
 9 and its complications (34.7 out of every one hundred thousand
 
10 residents), a rate that was one hundred thirty per cent higher
 
11 than that of any other racial group in Hawaii (15.1 out of every
 
12 one hundred thousand residents).  Of native Hawaiians, those of
 
13 pure Hawaiian descent had the highest mortality rate (93.3 out of
 
14 every one hundred thousand residents), a rate that was five
 
15 hundred eighteen per cent higher than that of any other racial
 
16 group in the State.
 
17      The legislature further finds that effective outpatient
 
18 self-management by persons with diabetes results directly in a
 
19 significant reduction in both the economic and human devastation
 
20 wrought by the disease.  There is ample evidence that tight
 
21 control of blood sugar levels through patient self-management can
 
22 dramatically lower the incidence of complications, increase life
 
23 expectancy, and significantly enhance the quality of life of
 

 
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 1 persons with diabetes.  In addition, studies show that providing
 
 2 individuals with diabetes with the appropriate supplies and
 
 3 training for self-management results in a decrease in health care
 
 4 services utilization and costs.  Hawaii fails to recover these
 
 5 cost savings, however, because most health plans only provide
 
 6 coverage for equipment and supplies, and do not cover diabetes
 
 7 self-management education and training.
 
 8      The purpose of this part is to require all individual
 
 9 accident and sickness health care policies providing health care
 
10 coverage, and all group health care contracts issued by health
 
11 maintenance organizations and mutual benefit societies, to
 
12 provide coverage for outpatient diabetes self-management
 
13 training, education, equipment, and supplies.
 
14      SECTION 3.  Chapter 431, Hawaii Revised Statutes, is amended
 
15 by adding a new section to article 10A to be appropriately
 
16 designated to read as follows:
 
17      "§431:10A-    Coverage for diabetes.  (a)  Each policy of
 
18 accident and sickness insurance providing coverage for health
 
19 care, other than an accident-only, specified disease, hospital
 
20 indemnity, medicare supplement, long-term care, or other limited
 
21 benefit health insurance policy, that is issued or renewed in
 
22 this State, shall provide coverage for outpatient diabetes self-
 
23 management training, education, equipment, and supplies, subject
 

 
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 1 to the same deductibles, copayment, and coinsurance requirements
 
 2 imposed for health coverage under the same policy, if:
 
 3      (1)  The equipment, supplies, training, and education are
 
 4           medically necessary;
 
 5      (2)  The equipment, supplies, training, and education are
 
 6           prescribed by a health care professional authorized to
 
 7           prescribe under subsection (b); and
 
 8      (3)  The outpatient self-management training and education
 
 9           is provided by a provider with qualifications as set
 
10           forth under subsection (c).
 
11      (b)  Diabetes equipment, supplies, and outpatient self-
 
12 management training and education covered under this section
 
13 shall be prescribed by a licensed physician or advanced practice
 
14 registered nurse with prescriptive authority.
 
15      (c)  Diabetes self-management training and education,
 
16 including medical nutrition training covered under this section
 
17 shall include medically necessary visits:
 
18      (1)  For persons who are newly diagnosed or have received no
 
19           prior diabetes education;
 
20      (2)  Following a diagnosis that represents a significant
 
21           change in the patient's symptoms or condition that
 
22           warrants changes in self-management; and
 
23      (3)  When reeducation or refresher training is prescribed by
 

 
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 1           a health care practitioner with prescribing authority.
 
 2      (d)  Covered services under subsection (c) shall be provided
 
 3 by:
 
 4      (1)  A licensed physician, nurse, or pharmacist;
 
 5      (2)  Other health care professional who satisfies the
 
 6           current professional educational requirements of the
 
 7           National Certification Board for Diabetes Educators and
 
 8           has completed a comprehensive course in diabetes self-
 
 9           management education and training; or
 
10      (3)  A certified diabetes educator.
 
11 This subsection is satisfied by providing program services in
 
12 group sessions.  Individual training sessions may be provided in
 
13 lieu of a group program if medically necessary and recommended by
 
14 the treating physician because of language or physical
 
15 challenges, for example, severely impaired hearing or sight.
 
16      (e)  In lieu of subsection (d), coverage shall be provided
 
17 for a program based upon for a diabetes program recognized by the
 
18 American Diabetes Association.
 
19      (f)  For purposes of this section:
 
20      "Diabetes equipment and supplies" means medically necessary
 
21 equipment and supplies, prescribed by a licensed physician or
 
22 advanced practice registered nurse with prescriptive authority,
 
23 including:
 

 
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 1      (1)  One blood glucose monitor per year, or as medically
 
 2           necessary as recommended by a physician;
 
 3      (2)  Blood glucose monitors for the legally blind;
 
 4      (3)  Test strips for glucose monitors;
 
 5      (4)  Visual reading and urine testing strips;
 
 6      (5)  Insulin preparations and glucagon;
 
 7      (6)  Insulin cartridges;
 
 8      (7)  Insulin cartridges for the legally blind;
 
 9      (8)  Drawing up devices and monitors for the visually
 
10           impaired;
 
11      (9)  Injection aids;
 
12     (10)  Syringes and lancets, including automatic lancing
 
13           devices;
 
14     (11)  Prescribed oral agents for controlling blood sugar that
 
15           are included on the plan formulary, or as otherwise
 
16           medically necessary as prescribed by a physician;
 
17     (12)  Podiatric services and appliances, as defined by
 
18           Medicare, for prevention of complications associated
 
19           with diabetes to the extent coverage is required under
 
20           Medicare; and
 
21     (13)  Any other device, medication, equipment, or supply, as
 
22           defined by Medicare beginning January 1, 1999, and is
 
23           effective six months after the coverage is required
 

 
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 1           under Medicare."
 
 2      SECTION 4.  Chapter 432, Hawaii Revised Statutes, is amended
 
 3 by adding a new section to article 1 to be appropriately
 
 4 designated and to read as follows:
 
 5      "§432:1-    Diabetes coverage.  All individual and group
 
 6 health care contracts under this chapter shall provide, to the
 
 7 extent provided under section 431:10A-   , coverage for
 
 8 outpatient diabetes self-management training, education,
 
 9 equipment, and supplies."
 
10      SECTION 5.  Section 432D-23, Hawaii Revised Statutes, is
 
11 amended to read as follows:
 
12      "§432D-23  Required provisions and benefits.
 
13 Notwithstanding any provision of law to the contrary, each
 
14 policy, contract, plan, or agreement issued in the State after
 
15 January 1, 1995, by health maintenance organizations pursuant to
 
16 this chapter, shall include benefits provided in sections
 
17 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
18 431:10A-116.5, 431:10A-116.6, [and] 431:10A-119, [and]
 
19 431:10-120, and 431:10A-   , and chapter 431M."
 
20      SECTION 6.  Notwithstanding sections 23-51 and 23-52, Hawaii
 
21 Revised Statutes, or any other law to the contrary, the
 
22 legislature shall not be required to pass concurrent resolutions
 
23 requesting the auditor to prepare an impact assessment report for
 

 
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 1 this Act.
 
 2                             PART III.
 
 3      SECTION 7.  Section 431M-5, Hawaii Revised Statutes, is
 
 4 amended by amending subsection (c) to read as follows:
 
 5      "(c)  A health insurance plan shall not impose rates, terms,
 
 6 or conditions including service limits and financial
 
 7 requirements, on serious mental illness benefits, if similar
 
 8 rates, terms, or conditions are not applied to services for other
 
 9 medical or surgical conditions.  This [subsection] chapter shall
 
10 not apply to [individual or group hospital or medical service
 
11 plan contracts, and nonprofit mutual benefit association and
 
12 health maintenance organization health plan contracts providing
 
13 coverage to employers with twenty-five or fewer employees, and
 
14 government employee health benefits plans under chapter 87; and
 
15 provided further that this subsection shall not apply to] QUEST
 
16 medical plans under the department of human services until
 
17 July 1, 2002."
 
18                             PART IV.
 
19      SECTION 8.  Act 121, Session Laws of Hawaii 1999, is amended
 
20 to by amending section 4 to read as follows:
 
21      "SECTION 4.  (a)  There is established, within the
 
22 [department of health] insurance division of the department of
 
23 commerce and consumer affairs for administrative purposes only,
 

 
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 1 the Hawaii mental health [insurance] task force to study the
 
 2 financial and social implications of mandated equal mental health
 
 3 and substance abuse insurance coverage in Hawaii.
 
 4      (b)  The task force shall be comprised of the following
 
 5 [twenty-two] twenty-one members[:
 
 6      (1)  One member of the senate committee on health and human
 
 7           services appointed by the president of the senate;
 
 8      (2)  One member of the house of representatives committee on
 
 9           health appointed by the speaker of the house of
 
10           representatives;
 
11      (2)  One] with one voting member from each of the following
 
12           organizations and agencies appointed by the [governor:]
 
13           the organization or agency:
 
14           (A)  Hawaii Medical Service Association;
 
15           (B)  Kaiser Permanente Medical Care Program;
 
16           (C)  Department of human services;
 
17           (D)  Department of health;
 
18           (E)  Equal Insurance Coalition;
 
19           (F)  NAMI, Oahu;
 
20           (G)  Hawaii Psychological Association;
 
21           (H)  Chamber of Commerce of Hawaii;
 
22           (I)  Hawaii Psychiatric Medical Association;
 
23           (J)  Hawaii Business Health Council;
 

 
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 1           (K)  [Hawaii Medical Association;] Hawaii Employers
 
 2                Council;
 
 3           (L)  Mental Health Association of Hawaii;
 
 4           (M)  National Federation of Independent Businesses;
 
 5           (N)  Hawaii Nurses' Association;
 
 6           (O)  [Hawaii Building and Trades Council;] Healthcare
 
 7                Association of Hawaii;
 
 8           (P)  Hawaii Business League;
 
 9           (Q)  A consumer from United Self-Help;
 
10           (R)  Hawaii Biodyne Inc.; 
 
11           (S)  Queen's Health Plans;
 
12           (T)  National Association of Social Workers, Hawaii
 
13                Chapter; and
 
14           (U)  A labor union selected by the insurance
 
15                commissioner.
 
16      [(3) The following members to be appointed by the task
 
17           force:
 
18           (A)  Two members representing mental health consumers;
 
19                and
 
20           (B)  One member representing small business
 
21                organizations in the state;
 
22      (4)  One member representing the University of Hawaii school
 
23           of public health, with expertise in biomedical
 

 
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 1           statistics or economics.] 
 
 2      (c)  The task force shall:
 
 3      (1)  Investigate ways to define and quantify unmet mental
 
 4           health and substance abuse needs in the State, and
 
 5           shall analyze possible outcome data collection measures
 
 6           in order to meaningfully measure and describe:
 
 7           (A)  The efficacy of mental health and substance abuse
 
 8                treatment in the State; and
 
 9           (B)  Unmet mental health and substance abuse treatment
 
10                needs;
 
11      (2)  Describe mental health and substance abuse coverage in
 
12           the State, including deductibles, copayments, and
 
13           covered illnesses and conditions;
 
14      (3)  Describe the relative costs of mental illness and
 
15           substance abuse coverage, and other health coverage in
 
16           the State;
 
17      (4)  Describe mental health and substance abuse treatment
 
18           utilization in the State by adults, adolescents, and
 
19           children;
 
20      (5)  Produce an analysis of the needs of individuals who
 
21           have exhausted their mental health or substance abuse
 
22           treatment benefits; and
 
23      (6)  Determine the effect of additional mandated [serious]
 

 
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 1           mental [illness] health insurance benefits [parity] on
 
 2           [mental health and substance abuse services] consumers,
 
 3           affected health plans, businesses, health care
 
 4           providers, and other concerned parties, including a
 
 5           review of the experience of health plans in providing
 
 6           the coverage, and an assessment of any impact on costs,
 
 7           services provided, and services utilization[; and
 
 8      (7)  Develop treatment and utilization guidelines for
 
 9           severe, biologically-based mental illnesses in addition
 
10           to those covered under this Act, including, but not
 
11           limited to:
 
12           (A)  Major depression;
 
13           (B)  Obsessive compulsive disorders;
 
14           (C)  Severe panic disorders;
 
15           (D)  Autism and pervasive development disorders;
 
16           (E)  Multiple personality disorder (disassociative
 
17                disorder);
 
18           (F)  Brain damage or disfunction as defined by
 
19                neuropsychological testing; and
 
20           (G)  Other severe and disabling mental disorders such
 
21                as severe anorexia, severe attention-
 
22                deficit/hyperactivity disorder, and severe
 
23                dyslexia].
 

 
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 1      (d)  The task force shall perform its duties as follows:
 
 2      (1)  [The task force shall not utilize any moneys from the
 
 3           general fund to support its functions.]  Members shall
 
 4           serve without compensation;
 
 5      (2)  A simple majority of the members of the task force
 
 6           shall constitute a quorum for the transaction of
 
 7           business, and all actions of the task force shall
 
 8           require the affirmative vote of a majority of the
 
 9           members present;
 
10      (3)  The task force may hold public hearings as frequently
 
11           as deemed necessary and feasible to receive testimony
 
12           on issues relative to the task force's investigation;
 
13           and
 
14      (4)  The task force may invite participants, including the
 
15           auditor or the auditor's representative, as deemed
 
16           necessary to effectuate its purposes.
 
17      (e)  The task force shall submit a report of its findings
 
18 and recommendations to the speaker of the house of
 
19 representatives, the president of the senate, and the governor no
 
20 later than twenty days before the convening of the regular
 
21 session of 2001, and shall be dissolved upon submittal of its
 
22 report.  [Provided that the task force shall submit the report of
 
23 its findings and recommendations concerning treatment and
 

 
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 1 utilization guidelines as required under subsection (c)(7) of
 
 2 this section, to the speaker of the house of representatives, the
 
 3 president of the senate, and the governor no later than twenty
 
 4 days before the convening of the regular session of 2000.]"
 
 5      SECTION 9.  Statutory material to be repealed is bracketed.
 
 6 New statutory material is underscored.
 
 7      SECTION 10.  This Act shall take effect upon its approval;
 
 8 provided that sections 3, 4, and 5 shall take effect on July 1,
 
 9 2001, or the earliest date after July 1, 2001, at which group
 
10 policies are renewed, whichever is later.