STAND. COM. REP. NO. 653

                                   Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 780
                                        S.D. 1




Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Ways and Means, to which was referred S.B.
No. 780 entitled: 

     "A BILL FOR AN ACT RELATING TO HEALTH INSURANCE,"

begs leave to report as follows:

     The purpose of this bill is to mandate health insurance
coverage for medical foods and low-protein modified food products
needed for the treatment of inherited metabolic diseases.

     In addition, this bill:

     (1)  Requires a medical food or low-protein modified food
          product to be prescribed as medically necessary for the
          therapeutic treatment of an inherited metabolic
          disease; and to be consumed or administered enterally
          under the supervision of a licensed physician;

     (2)  Mandates coverage for at least eighty per cent of the
          cost of the prescribed medical food or low-protein
          modified food product; and

     (3)  Requires every insurer to provide notice to its
          policyholders regarding the coverage mandated by this
          bill by December 31, 2000, or within calendar year 2000
          when annual information is made available to members,
          whichever comes sooner.

 
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     Your Committee finds it unthinkable that providers of health
insurance could possibly deny a person coverage for medical foods
and low-protein modified food products needed for the treatment
of inherited metabolic diseases.  If a person were allergic to a
specific antibiotic or infected by a strain of bacteria already
known to be resistant to a specific antibiotic, it would be
irresponsible for providers of health insurance to even think of
denying the person coverage for a type of antibiotic that did not
cause an allergic reaction in the person or that was known to be
still effective against the strain of bacteria.  And yet, your
Committee finds that it is necessary to require providers of
health insurance to cover these medical foods and low-protein
modified food products.

     Your Committee has amended this bill by replacing the term
"inherited metabolic diseases" with "inborn errors of metabolism"
to reflect the possibility that some metabolic diseases may be
caused by other factors--such as mutagenesis, and may not be
inherited by a person in the same manner that eye color or hair
color are inherited.

     Your Committee believes that this bill should not be used by
unethical persons as justification to make unsubstantiated
medical claims about a medical food or low-protein modified food
product, or to undertake unproven treatment protocols for inborn
errors of metabolism.  It is your Committee's expectation that
manufacturers of these foods and food products will abide by all
applicable state and federal food and drug laws, and that
physicians will prescribe these foods and food products within
the ethical bounds of their professions.

     As affirmed by the record of votes of the members of your
Committee on Ways and Means that is attached to this report, your
Committee is in accord with the intent and purpose of S.B. No.
780, as amended herein, and recommends that it pass Third Reading
in the form attached hereto as S.B. No. 780, S.D. 1.


 
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                                   STAND. COM. REP. NO. 653
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                                 Respectfully submitted on behalf
                                 of the members of the Committee
                                 on Ways and Means,



                                 ________________________________
                                 CAROL FUKUNAGA, Co-Chair



                                 ________________________________
                                 ANDREW LEVIN, Co-Chair

 
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