HB2240

Report Title:

Mental Health and Substance Abuse; Full Parity

Description:

Requires that rates, terms, and conditions for mental health, alcohol, and drug abuse treatment be equivalent to those applicable to other medical or surgical conditions.

HOUSE OF REPRESENTATIVES	H.B. NO.	2240
TWENTY-FIRST LEGISLATURE, 2002
STATE OF HAWAII

A BILL FOR AN ACT

 

relating to mental health and alcohol and drug abuse treatment insurance benefits.

 

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

SECTION 1. Section 431M-4, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) The covered benefit under this chapter shall not be [less] fewer than thirty days of in-hospital services per year. Each day of in-hospital services may be exchanged for two days of nonhospital residential services, two days of partial hospitalization services, or two days of day treatment services. Visits to a physician, psychologist, clinical social worker, or advanced practice registered nurse with a psychiatric or mental health specialty or subspecialty shall not be [less] fewer than thirty visits per year to hospital or nonhospital facilities or to mental health outpatient facilities for day treatment or partial hospitalization services. Each day of in-hospital services may also be exchanged for two outpatient visits under this chapter; provided that the patient's condition is such that the outpatient services would reasonably preclude hospitalization. The total covered benefit for outpatient services in subsections (b) and (c) shall not be [less] fewer than twenty-four visits per year; provided that coverage of twelve of the twenty-four outpatient visits shall apply only to the services under subsection (c). The other covered benefits under this chapter shall apply to any of the services in subsection (b) or (c). [In the case of alcohol and drug dependence benefits, the insurance policy may limit the number of treatment episodes but may not limit the number to less than two treatment episodes per lifetime. Nothing in this section shall be construed to limit serious mental illness benefits.]

(b) Alcohol and drug dependence benefits shall be as follows:

(1) Detoxification services as a covered benefit under this chapter shall be provided either in a hospital or in a nonhospital facility [which] that has a written affiliation agreement with a hospital for emergency, medical, and mental health support services. The following services shall be covered under detoxification services:

(A) Room and board;

(B) Diagnostic x-rays;

(C) Laboratory testing; and

(D) Drugs, equipment use, special therapies, and supplies.

Detoxification services shall be included as part of the covered in-hospital services[, but shall not be included in the treatment episode limitation, as specified in subsection (a)];

(2) Alcohol or drug dependence treatment through in-hospital, nonhospital residential, or day treatment substance abuse services as a covered benefit under this chapter shall be provided in a hospital or nonhospital facility. Before a person qualifies to receive benefits under this subsection, a qualified physician, psychologist, clinical social worker, or advanced practice registered nurse shall determine that the person suffers from alcohol or drug dependence, or both. The substance abuse services covered under this paragraph shall include those services [which] that are required for licensure and accreditation, and shall be included as part of the covered in-hospital services as specified in subsection (a). Excluded from alcohol or drug dependence treatment under this subsection are detoxification services and educational programs to which drinking or drugged drivers are referred by the judicial system, and services performed by mutual self-help groups; and

(3) Alcohol or drug dependence outpatient services as a covered benefit under this chapter shall be provided under an individualized treatment plan approved by a qualified physician, psychologist, clinical social worker, or advanced practice registered nurse and [must] shall be services reasonably expected to produce remission of the patient's condition. An individualized treatment plan approved by a clinical social worker or an advanced practice registered nurse for a patient already under the care or treatment of a physician or psychologist shall be done in consultation with the physician or psychologist. Services covered under this paragraph shall be included as part of the covered outpatient services as specified in subsection (a)."

SECTION 2. Section 431M-5, Hawaii Revised Statutes, is amended by amending subsections (b) and (c) to read as follows:

"(b) Notwithstanding subsection (a), health maintenance organizations may establish reasonable provisions for enrollee cost-sharing so long as the amount the enrollee is required to pay does not exceed the amount of copayment and deductible customarily required by insurance policies [which] that are subject to the provisions of this chapter for this type and level of service. [Nothing in this chapter prevents health maintenance organizations from establishing durational limits which are actuarially equivalent to the benefits required by this chapter.] Health maintenance organizations may limit the receipt of covered services by enrollees to services provided by or upon referral by providers associated with the health maintenance organization.

(c) A health insurance plan shall not impose rates, terms, or conditions, including service limits and financial requirements, on [serious] mental illness and alcohol and drug dependence benefits, if similar rates, terms, or conditions are not applied to services for other medical or surgical conditions. [This chapter shall not apply to individual contracts; provided further that this chapter shall not apply to QUEST medical plans under the department of human services until July 1, 2002.]"

SECTION 3. Section 431M-1, Hawaii Revised Statutes, is amended by deleting the definition "serious mental illness".

[""Serious mental illness" means schizophrenia, schizo-affective disorder, and bipolar mood disorder, as defined in the most recent version of the Diagnostic and Statistical Manual of the American Psychiatric Association, which is of sufficient severity to result in substantial interference with the activities of daily living."]

SECTION 4. Section 3 of Act 202, Session Laws of Hawaii 1988, as amended by section 4 of Act 111, Session Laws of Hawaii 1994, as amended by section 3 of Act 78, Session Laws of Hawaii 1998, is amended to read as follows:

"SECTION 3. This Act shall take effect on July 1, 1989; provided that insurance or health or service plan contracts shall be amended to reflect the provisions required under this Act at the first anniversary date following the effective date, but no later than July 1, 1990; provided further that section

431M-6 shall take effect upon the approval of this Act[; and provided further that this Act shall be repealed on July 1, 2002]."

SECTION 5. Act 121, Session Laws of Hawaii 1999, as amended by Act 243, Session Laws of Hawaii 2000, is amended by amending subsection (e) of section 4 to read as follows:

"(e) The task force shall submit a report of its findings and recommendations to the speaker of the house of representatives, the president of the senate, and the governor no later than twenty days before the convening of the regular session of 2001[.], and shall be dissolved on July 1, 2002."

SECTION 6. Act 121, Session Laws of Hawaii 1999, as amended by section 8 of Act 243, Session Laws of Hawaii 2000, is amended by amending section 6 to read as follows:

"SECTION 6. This Act shall take effect on July 1, 1999; provided that insurance, health, or service plan contracts subject to the terms of this Act and issued or renewed after December 31, 1999, shall be amended to be consistent with this Act[; and provided that this Act shall be repealed on June 30, 2003]."

SECTION 7. Act 243, Session Laws of Hawaii 2000, is amended by amending section 11 to read as follows:

"SECTION 11. This Act shall take effect on July 1, 2001; provided that:

(1) Sections 6, 7, and 8 shall take effect upon approval; and

(2) [Sections] Section 6 [and 7] shall be repealed on June 30, 2003; and [sections] section 431:2-216 [and 431M-5], Hawaii Revised Statutes, [are] is reenacted in the form in which [they] it read on the day before approval of this Act."

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

SECTION 9. This Act shall take effect on June 30, 2002.

INTRODUCED BY:

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