Bill Text: HI SB225 | 2017 | Regular Session | Amended
Bill Title: Relating To Health Coverage For Brain Injuries.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2017-02-07 - Report adopted; Passed Second Reading, as amended (SD 1) and referred to WAM. [SB225 Detail]
Download: Hawaii-2017-SB225-Amended.html
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THE SENATE |
S.B. NO. |
225 |
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TWENTY-NINTH LEGISLATURE, 2017 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH COVERAGE FOR BRAIN INJURIES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that traumatic brain injury is damage to the brain caused by an external force. Traumatic brain injury may produce a diminished or altered state of consciousness and may result in an impairment of cognitive abilities or physical functioning.
The legislature further finds that traumatic brain injury is a leading cause of death and disability among children and young adults. While survivors of traumatic brain injury can lead full lives, thanks to lifesaving medical techniques and rehabilitation services, they face a long rehabilitation process that may not be covered by certain health benefit plans.
The purpose of this Act is to require health insurers, mutual benefit societies, and health maintenance organizations to provide coverage for cognitive rehabilitation therapy for survivors of traumatic brain injuries.
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- Cognitive rehabilitation therapy; coverage; notice. (a) Notwithstanding any other law to the contrary, each individual and group accident and health or sickness insurance policy issued or renewed in the State after December 31, 2018, shall provide coverage for cognitive rehabilitation therapy, as a result of and related to a traumatic brain injury, for the policyholder and individuals covered under the individual and group accident and health or sickness insurance policy.
(b) Cognitive rehabilitation therapy provided pursuant to this section shall be:
(1) Covered for up to twenty years from the date the traumatic brain injury occurred; and
(2) Subject to a maximum benefit of $300,000 per insured, unless the individual and group accident and health or sickness insurance policy states otherwise.
(c) Coverage under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, and annual or maximum payment limits applicable to other similar coverage under the policy.
(d) Each individual and group accident and health or sickness insurance policy that includes coverage as required pursuant to this section shall provide payment or reimbursement for cognitive rehabilitation therapy that is considered medically necessary as defined in section 432E-1.4.
(e) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. Notice shall be in writing and in literature or correspondence sent to policyholders beginning with calendar year 2018 along with any other mailing to policyholders, but in no case later than December 31, 2018.
(f) This section shall not apply to limited benefit health insurance as provided pursuant to section 431:10A-102.5.
(g) For the purposes of this section, "cognitive rehabilitation therapy" means a systematic, functionally-oriented service of therapeutic cognitive activities, based on an assessment and understanding of a person's brain-behavior deficits. Cognitive rehabilitation therapy services are directed to achieve functional changes by:
(1) Reinforcing, strengthening, or reestablishing previously learned patterns of behavior; or
(2) Establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems."
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- Cognitive rehabilitation therapy; coverage; notice. (a) Notwithstanding any other law to the contrary, each individual and group hospital or medical service plan contract issued or renewed in the State after December 31, 2018, shall provide coverage for cognitive rehabilitation therapy, as a result of and related to a traumatic brain injury, for the member and individuals covered under the individual and group hospital or medical service plan contract.
(b) Cognitive rehabilitation therapy provided pursuant to this section shall be:
(1) Covered for up to twenty years from the date the traumatic brain injury occurred; and
(2) Subject to a maximum benefit of $300,000 per insured, unless the individual and group hospital or medical service plan contract states otherwise.
(c) Coverage under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, and annual or maximum payment limits applicable to other similar coverage under the plan contract.
(d) Each individual and group hospital or medical service plan contract that includes coverage as required pursuant to this section shall provide payment or reimbursement for cognitive rehabilitation therapy that is considered medically necessary as defined in section 432E-1.4.
(e) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. Notice shall be in writing and in literature or correspondence sent to members beginning with calendar year 2018 along with any other mailing to members, but in no case later than December 31, 2018.
(f) This section shall not apply to limited benefit health insurance as provided pursuant to section 431:10A-102.5.
(g) For the purposes of this section, "cognitive rehabilitation therapy" means a systematic, functionally-oriented service of therapeutic cognitive activities, based on an assessment and understanding of a person's brain-behavior deficits. Cognitive rehabilitation therapy services are directed to achieve functional changes by:
(1) Reinforcing, strengthening, or reestablishing previously learned patterns of behavior; or
(2) Establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems."
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 benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A- , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 4 of this Act shall take effect for all policies, contracts, plans, or agreements issued in the State of Hawaii after December 31, 2018.
SECTION 6. (a) The auditor is requested to conduct a follow up analysis to the 2004 auditor's report, Assessment of Proposed Mandatory Health Insurance for Cognitive Rehabilitation, Report No. 04-11. The auditor is requested to assess and update the findings in Report No. 04-11 to reflect the wide range of studies on the treatment of traumatic brain injuries that have been published since Report No. 04-11 and conduct an analysis on the economic impact that the expanded coverage under this Act will have on affected providers of health insurance.
(b) The auditor shall report the auditor's findings and recommendations to the legislature no later than twenty days prior to the convening of the regular session of 2018.
SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 8. This Act shall take effect upon its approval.
Report Title:
Mandated Coverage; Cognitive Rehabilitation Therapy; Traumatic Brain Injury
Description:
Requires health insurers, mutual benefit societies, and health maintenance organizations to provide coverage beginning 1/1/2018 for medically necessary cognitive rehabilitation therapy for survivors of traumatic brain injury. Requires coverage for up to twenty years from the date the traumatic brain injury occurred and imposes a lifetime cap of $300,000 per person. Requests the auditor to update the 2004 auditor's report on cognitive rehabilitation and report back to the legislature. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
