Bill Text: HI SB304 | 2010 | Regular Session | Introduced

---

Bill Title: Health Insurance; Mental Health, Alcohol and Drug Abuse Treatment Parity

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB304 Detail]

Download: Hawaii-2010-SB304-Introduced.html

---

Report Title:

Health Insurance; Mental Health, Alcohol and Drug Abuse Treatment Parity

 

Description:

Provides parity by removing all rates, terms, or conditions, including service limits and financial requirements, on mental health and alcohol and drug abuse treatment benefits coverage.

 

THE SENATE	S.B. NO.	304
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII

A BILL FOR AN ACT

 

 

relating to insurance benefits.

 

 

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

 

     SECTION 1.  Chapter 431M, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§431M‑A  Parity of coverage and rates.  (a)  An insurer subject to section 431M-2 shall provide a covered benefit under this chapter without imposing any rate, term, or condition, including but not limited to deductibles, co-payment plans, and other limitations on payment, that places a greater financial burden on an insured for access to a covered benefit under this chapter than for access to treatment for any other physical health conditions or diseases.  Any deductible or out-of-pocket limits required under any policy coverage under section 431M-2 shall be comprehensive for coverage of both a covered benefit under this chapter and a physical health condition or disease.

     (b)  A policy coverage under section 431M-2 shall be construed in compliance with subsection (a) if at least one choice for treatment under this chapter provided to the insured within the plan has rates, terms, and conditions that place no greater financial burden on the insured than for access to treatment for any other physical health conditions or diseases.

     (c)  A policy coverage under section 431M-2 shall provide treatment benefits to the same extent as for any other physical illnesses and diseases."

     SECTION 2.  Section 431M-1, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows:

     ""Rate, term, or condition" means any lifetime or annual payment limits, deductibles, co-payments, co-insurance, and any other cost-sharing requirements, out-of-pocket limits, visit limits, and any other financial component of health insurance coverage that affects the insured."

     SECTION 3.  Section 431M-2, Hawaii Revised Statutes, is amended to read as follows:

     "§431M-2  Policy coverage[.]; nondiscrimination; rules.  (a)  All individual and group accident and health or sickness insurance policies issued in this State, individual or group hospital or medical service plan contracts, [and] nonprofit mutual benefit society and health maintenance organization health plan contracts, and QUEST medical plans shall include within their hospital and medical coverage the benefits of alcohol dependence, drug dependence, and mental illness treatment services provided in section 431M-4 except that this section shall not apply to insurance policies that are issued solely for single diseases, or otherwise limited, specialized coverage.

     (b)  Any policy issued under subsection (a) that does not otherwise provide for management of care under the plan, or that does not provide for the same degree of management of care for all health conditions, may provide coverage for treatment of mental illness, alcohol, and drug dependence through a managed care organization; provided that the managed care organization is in compliance with the rules adopted by the insurance commissioner that ensure that the system for delivery of treatment for mental illness does not diminish or negate the purpose of this section.  The rules adopted by the insurance commissioner shall ensure that:

     (1)  Timely and appropriate access to care is available;

     (2)  The quantity, location, and specialty distribution of health care providers is adequate; and

     (3)  Administrative or clinical protocols do not serve to reduce access to medically necessary treatment for any insured.

     (c)  To be eligible for coverage under this section, the service shall be rendered:

     (1)  By a licensed or certified mental health professional; or

     (2)  In a mental health outpatient facility that provides a program for the treatment of mental illness pursuant to a written plan.

     (d)  The insurance commissioner shall adopt rules pursuant to chapter 91 to implement this section."

     SECTION 4.  Section 431M-4, Hawaii Revised Statutes, is amended to read as follows:

     "§431M-4  Mental illness, alcohol and drug dependence benefits.  (a)  The covered benefit under this chapter shall [not be less 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] be limited to visits to a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse [shall not be less 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 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.] and shall be in accordance with section 431M-A.  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 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, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse shall determine that the person suffers from alcohol or drug dependence, or both; provided that the substance abuse services covered under this paragraph shall include those services that are required for licensure and accreditation and shall be [included as part of the covered in-hospital services as specified in subsection (a).] in accordance with section 431M-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;

     (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, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse and shall be services reasonably expected to produce remission of the patient's condition.  An individualized treatment plan approved by a marriage and family therapist, licensed mental health counselor, licensed 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);] in accordance with section 431M-A; and

     (4)  Substance abuse assessments for alcohol or drug dependence as a covered benefit under this section for a child facing disciplinary action under section 302A‑1134.6 shall be provided by a qualified physician, psychologist, licensed clinical social worker, advanced practice registered nurse, or certified substance abuse counselor.  The certified substance abuse counselor shall be employed by a hospital or nonhospital facility providing substance abuse services.  The substance abuse assessment shall evaluate the suitability for substance abuse treatment and placement in an appropriate treatment setting.

     (c)  Mental illness benefits.

     (1)  Covered benefits for mental health services set forth in this subsection shall be limited to coverage for diagnosis and treatment of mental disorders.  All mental health services shall be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse and must be reasonably expected to improve the patient's condition.  An individualized treatment plan approved by a licensed clinical social worker, marriage and family therapist, licensed mental health counselor, 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;

     (2)  In-hospital and nonhospital residential mental health services as a covered benefit under this chapter shall be provided in a hospital or a nonhospital residential facility.  The services to be covered shall include those services required for licensure and accreditation, and shall be [included as part of the covered in-hospital services as specified in subsection (a);] in accordance with section 431M-A;

     (3)  Mental health partial hospitalization as a covered benefit under this chapter shall be provided by a hospital or a mental health outpatient facility.  The services to be covered under this paragraph shall include those services required for licensure and accreditation and shall be [included as part of the covered in-hospital services as specified in subsection (a);] in accordance with section 431M-A; and

     (4)  Mental health outpatient services shall be [a covered benefit under this chapter and shall be included as part of the covered outpatient services as specified in subsection (a).] in accordance with section 431M‑A."

     SECTION 5.  Section 431M-5, Hawaii Revised Statutes, is repealed.

     ["§431M-5  Nondiscrimination in deductibles, copayment plans, and other limitations on payment.  (a)  Deductible or copayment plans may be applied to benefits paid to or on behalf of patients during the course of treatment as described in section 431M-4, but in any case the proportion of deductibles or copayments shall be not greater than those applied to comparable physical illnesses generally requiring a comparable level of care in each policy.

     (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 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 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 6.  This Act shall be exempt from the impact assessment report by the auditor under section 23-51, Hawaii Revised Statutes.  The legislature finds that any slight financial impact of this Act of a rise in premiums is likely to be incalculable (Auditor Report No. 88-6).

     SECTION 7.  The insurance commissioner shall submit a report to the legislature and the governor no later than January 15, 2010, on the following:

     (1)  An estimate of the impact of this Act on health insurance costs;

     (2)  Actions taken by the insurance commissioner to ensure that policies issued under section 431M-2, Hawaii Revised Statutes, are in compliance with this Act and that quality and access to treatment for mental illness provided by the plans are not compromised by providing financial parity for such coverage;

     (3)  When a policy issued under section 431M-2, Hawaii Revised Statutes, offers choices for treatment of mental illness and alcohol and drug dependence, an analysis and comparison of those choices in regard to level of access, choice, and financial burden; and

     (4)  Identification of any segments of the population of Hawaii that may be excluded from access to treatment for mental illness at the level provided by this Act, including an estimate of the number of residents excluded from such access under health benefit plans offered or administered by employers who receive the majority of their annual revenues from contracts, grants, or other expenditures by state agencies.

     SECTION 8.  (a)  This Act shall not be construed to:

     (1)  Limit the provision of specialized medicaid covered services for individuals with mental illness;

     (2)  Contravene the provisions of federal law, federal or state medicaid policy, or the terms and conditions imposed on any medicaid waiver granted to the State with respect to the provision of services to individuals with mental illness; and

     (3)  Affect any annual health insurance policy issued under section 431M-2, Hawaii Revised Statutes, until its date of renewal or any health insurance plan governed by a collective bargaining agreement or employment contract until the expiration of that contract.

     (b)  Any rules relating to eligibility for payment for treatment of mental illness shall remain in effect until the effective date of this Act and thereafter shall be deemed to be the rules adopted by the insurance commissioner under section 431M-2, Hawaii Revised Statutes, to the extent that they are consistent with this Act and until amended or repealed by the insurance commissioner.

     SECTION 9.  In codifying the new section added by section 1 of this Act, the revisor of statutes shall substitute an appropriate section number for the letter used in designating the new section in this Act.

     SECTION 10.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

    

     SECTION 11.  This Act shall take effect upon its approval.

 

INTRODUCED BY:	_____________________________