Bill Text: HI SB795 | 2010 | Regular Session | Introduced

Hawaii Senate Bill 795 (Prior Session Legislation)

Introduced

Bill Title: Mandatory Health Coverage; Early Intervention Services

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Introduced - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB795 Detail]

Download: Hawaii-2010-SB795-Introduced.html

Report Title:

Mandatory Health Coverage; Early Intervention Services

Description:

Requires all health insurers, mutual benefit societies, and health maintenance organizations to provide mandatory coverage for all policyholders, members, subscribers, and individuals from birth to age three for medically necessary early intervention services.

THE SENATE	S.B. NO.	795
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO HEALTH INSURANCE.

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

SECTION 1. The purpose of this Act is to ensure the provision of quality health care for all Hawaii residents by requiring coverage of medically necessary early intervention services for infants and toddlers from birth to age three.

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‑ Early intervention services; benefits and coverage; notice; definitions. (a) Any other law to the contrary notwithstanding, each employer group health insurance policy, contract, plan, or agreement issued or renewed in this State after December 31, 2009, shall provide to the policyholder and infants and toddlers with special needs from birth to age three covered under the policy, contract, plan, or agreement, coverage for medically necessary early intervention services including both rehabilitative therapy and developmental therapy.

(b) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders when annual information is made available to policyholders, or in any other mailing to policyholders.

(c) Coverage provided under this section shall be subject to a maximum benefit of $75,000 per year, but shall not be subject to any limits on the number of visits to a provider of early intervention services. After December 31, 2011, the insurance commissioner, on an annual basis, shall adjust the maximum benefit for inflation using the medical care component of the United States Department of Labor consumer price index for all urban consumers. No later than April 1 of each calendar year, the commissioner shall publish the adjusted maximum benefit that shall apply during the following calendar year to health insurance policies subject to this section. Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, service, or item, the provision of which was for the treatment of a health condition unrelated to the covered individual's early intervention services, shall not be applied toward any maximum benefit established under this subsection.

(d) Coverage under this section shall be subject to copayment, deductible, and coinsurance provisions of a health insurance policy to the extent that other medical services covered by the policy are subject to these provisions.

(e) This section shall not be construed as limiting benefits that are otherwise available to an individual under a health insurance policy.

(f) As used in this section, unless the context clearly requires otherwise:

"Biological risk" means prenatal, perinatal, neonatal, or early developmental events suggestive of biological insults to the developing central nervous system which increase the probability of delayed development.

"Case management" means an ongoing service of shared responsibility between families and professionals that identifies needs and assists in obtaining coordinated, appropriate services and resources.

"Delayed development" means a significant delay in one or more of the following areas of development: cognition, speech, language, physical, motor, vision, hearing, psychosocial, or self-help skills.

"Department" means the department of health.

"Director" means the director of health.

"Early intervention services" means services that:

(1) Are provided under public supervision;

(2) Are provided by qualified professional and paraprofessional personnel;

(3) Are provided in conformity with an individualized family support plan; and

(4) Include but are not limited to: family support, counseling, and home visits; special instruction; speech pathology and audiology; music therapy; occupational therapy; physical therapy; psychological services; case management services; medical services only for diagnostic or evaluation purposes; early identification, screening, and assessment services; and health services necessary to enable the infant or toddler to benefit from the other early intervention services.

"Environmental risk" means physical, social, or economic factors that may limit development. Environmental risk includes but is not limited to the following conditions:

(1) Birthweight between 1,500 and 2,500 grams, in combination with any other environmental risk factor;

(2) Parental age less than sixteen;

(3) Parental age between sixteen and eighteen and less than a high school education in combination with any other environmental risk factor;

(4) Any existing physical, developmental, emotional, or psychiatric disability in a primary caregiver;

(5) Presence of physical, developmental, emotional, or psychiatric disability in a sibling or any other family member in the home in combination with any other environmental risk factor;

(6) Abuse of any legal or illegal substance by a primary caregiver;

(7) Child abuse and neglect of target child or siblings;

(8) Economically disadvantaged family in combination with any other environmental risk factor;

(9) Single parent in combination with any other environmental risk factor; and

(10) Incarceration of a primary caregiver in combination with any other environmental risk factor.

"Health insurance policy" means any group health, sickness, or accident policy or subscriber contract or certificate issued by an insurance entity subject to this section.

"Individual family support plan" means a dynamic, voluntary plan of action and support developed by families and professionals that emanates from the families' expressions of needs and goals.

"Infants and toddlers with special needs" means infants and toddlers from birth to the age of three with delayed development, biological risk, or environmental risk.

"Medically necessary" means any care, treatment, intervention, service, or item that is prescribed, provided, or ordered by a physician, psychologist, or registered nurse practitioner licensed to practice in this State in accordance with accepted standards or practice and that is reasonably expected to accomplish any of the following:

(1) Prevent the onset of an illness, condition, injury, or disability;

(2) Reduce or ameliorate the physical, mental, or developmental effects of an illness, condition, injury, or disability; or

(3) Assist in achieving or maintaining maximum functional capacity in performing daily activities, taking into account both the functional capacity of the recipient and those functional capacities that are appropriate to recipients of care of the same age."

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‑ Early intervention services; benefits and coverage; notice; definitions. (a) Any other law to the contrary notwithstanding, each individual and group hospital or medical service plan, policy, contract, or agreement issued or renewed in this State after December 31, 2009, shall provide to the member and infants and toddlers with special needs from birth to age three covered under the policy, contract, plan, or agreement, coverage for medically necessary early intervention services including both rehabilitative therapy and developmental therapy.

(b) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members when annual information is made available to members, or in any other mailing to members.

(c) Coverage provided under this section shall be subject to a maximum benefit of $75,000 per year, but shall not be subject to any limits on the number of visits to a provider of early intervention services. After December 31, 2011, the insurance commissioner, on an annual basis, shall adjust the maximum benefit for inflation using the medical care component of the United States Department of Labor consumer price index for all urban consumers. No later than April 1 of each calendar year, the commissioner shall publish the adjusted maximum benefit that shall apply during the following calendar year to health insurance policies subject to this section. Payments made by a mutual benefit society on behalf of a covered individual for any care, treatment, intervention, service, or item, the provision of which was for the treatment of a health condition unrelated to the covered individual's early intervention services, shall not be applied toward any maximum benefit established under this subsection.