Report Title:

Marriage and Family Therapists; Reimbursable Services

 

Description:

Includes marriage and family therapy among the mental illness, alcohol and drug dependence benefits required within the hospital and medical coverage offered under accident and sickness insurance policies and similar insurance products

 


HOUSE OF REPRESENTATIVES

H.B. NO.

1047

TWENTY-FOURTH LEGISLATURE, 2007

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT


 

 

RELATING TO MARRIAGE AND FAMILY THERAPISTS.

 

 

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

 


     SECTION 1.  Section 431M-1, Hawaii Revised Statutes, is amended to read as follows:

     "§431M-1  Definitions.  Whenever used in this chapter, unless the context otherwise requires:

     "Advanced practice registered nurse" means a person recognized as such pursuant to chapter 457.

     "Alcohol dependence" means any use of alcohol which produces a pattern of pathological use causing impairment in social or occupational functioning or produces physiological dependency evidenced by physical tolerance or withdrawal.

     "Alcohol or drug dependence outpatient services" means alcohol or drug dependence nonresidential treatment provided on an ambulatory basis to patients with alcohol or drug dependence problems that includes interventions prescribed and performed by qualified physicians, psychologists, licensed clinical social workers, marriage and family therapist, or advanced practice registered nurses.  This definition shall not imply a broadening of the scope of or granting of prescriptive authority privileges, except as otherwise allowed pursuant to chapter 457.

     "Certified substance abuse counselor" means a person who is certified pursuant to section 321-193.

     "Day treatment services" means treatment services provided by a hospital, mental health outpatient facility, or nonhospital facility to patients who, because of their conditions, require more than periodic hourly service.  Day treatment services shall be prescribed by a physician, psychologist, licensed clinical social worker, marriage and family therapist, or advanced practice registered nurse, and carried out under the supervision of a physician, psychologist, licensed clinical social worker, marriage and family therapist, or advanced practice registered nurse.  Day treatment services require less than twenty-four hours of care and a minimum of three hours in any one day.

     "Detoxification services" means the process whereby a person intoxicated by alcohol, drugs, or both, or a person who is dependent upon alcohol, drugs, or both, is assisted through the period of time necessary to eliminate, by metabolic or other means, the intoxicating alcohol or drug dependency factors, as determined by a physician or advanced practice registered nurse, while keeping the physiological risk to the person at a minimum.

     "Drug dependence" means any pattern of pathological use of drugs causing impairment in social or occupational functioning and producing psychological or physiological dependency or both, evidenced by physical tolerance or withdrawal.

     "Hospital" means a facility licensed as a hospital by the department of health and accredited by the Joint Commission on Accreditation of Health Care Organizations.

     "In-hospital services" means the provision of medical, nursing, or therapeutic services twenty-four hours a day in a hospital.

     "Licensed clinical social worker" means a person who is a licensed clinical social worker pursuant to chapter 467E.

     "Marriage and family therapist" means a person licensed in marriage and family therapy practice pursuant to chapter 451J.

     "Mental health outpatient facility" means a mental health establishment, clinic, institution, center, or community mental health center, that provides for the diagnosis, treatment, care, or rehabilitation of mentally ill persons, that has been accredited by the Joint Commission on Accreditation of Health Care Organizations or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health.

     "Mental health outpatient services" means mental health nonresidential treatment provided on an ambulatory basis to patients with mental illness that includes interventions prescribed and performed by a physician, psychologist, licensed clinical social worker, marriage and family therapist, or advanced practice registered nurse.

     "Mental illness" means a syndrome of clinically significant psychological, biological, or behavioral abnormalities that results in personal distress or suffering, impairment of capacity for functioning, or both.  For the purposes of this chapter, the terms "mental disorder" and "mental illness" shall be used interchangeably and shall include the definitions identified in the most recent publications of the Diagnostic and Statistical Manual of the American Psychiatric Association or International Classification of Disease.  Epilepsy, senility, mental retardation, or other developmental disabilities and addiction to or abuse of intoxicating substances do not in and of themselves constitute a mental disorder.

     "Nonhospital facility" means a facility for the care or treatment of alcohol dependent, drug dependent, or mentally ill persons, which has been accredited by the Joint Commission on Accreditation of Health Care Organizations or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health and, if residential, has been licensed as a special treatment facility by the department of health.

     "Nonhospital residential services" means the provision of medical, psychological, nursing, counseling, or therapeutic services to patients suffering from alcohol dependence, drug dependence, or mental illness by a nonhospital residential facility, according to individualized treatment plans.

     "Partial hospitalization services" means treatment services, including in-hospital treatment services or benefits, provided by a hospital or mental health outpatient facility to patients who, because of their conditions, require more than periodic hourly service.  Partial hospitalization services shall be prescribed by a physician or psychologist, and may be prescribed by a marriage and family therapist or licensed clinical social worker in consultation with a physician or psychologist or an advanced practice registered nurse in consultation with a physician or psychologist.  Partial hospitalization services require less than twenty-four hours of care and a minimum of three hours in any one day.

     "Physician" means a person licensed in the practice of medicine or osteopathy pursuant to chapter 453 or 460, respectively.

     "Psychologist" means a person licensed in the practice of psychology pursuant to chapter 465.

     "Qualified" means:

     (1)  Having skill in the diagnosis or treatment of substance use disorders, based on a practitioner's credentials, including but not limited to professional education, clinical training, licensure, board or other certification, clinical experience, letters of reference, other professional qualifications, and disciplinary action; or

     (2)  Being a licensed physician, psychologist, licensed clinical social worker, marriage and family therapist, or advanced practice registered nurse, and certified pursuant to chapter 321.

     "Serious mental illness" means a mental disorder consisting of at least one of the following:  schizophrenia, schizo-affective disorder, bipolar types I and II, obsessive compulsive disorder, dissociative disorder, delusional disorder, and major depression, as defined in the most recent version of the Diagnostic and Statistical Manual of the American Psychiatric Association and which is of sufficient severity to result in substantial interference with the activities of daily living.

     "Substance abuse services" means the provision of medical, psychological, nursing, counseling, or therapeutic services in response to a treatment plan for alcohol or drug dependence or both which shall include, when appropriate, a combination of aftercare and individual, group, and family counseling services provided by qualified staff.

     "Treatment episode" means one admission to an accredited hospital or nonhospital facility, or office of a qualified physician, psychologist, licensed clinical social worker, marriage and family therapist, or advanced practice registered nurse for treatment of alcohol or drug dependence, or both, as stipulated in a prescribed treatment plan and that would generally produce remission in those who complete the treatment.  The prescribed treatment plan may include the provision of substance abuse services in more than one location and may include in-hospital, nonhospital residential, day treatment, or alcohol or drug dependence outpatient services, or any combination thereof.  An admission for only detoxification services shall not constitute a treatment episode."

     SECTION 2.  Section 431M-3, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  Covered benefits for alcohol dependence, drug dependence, or mental illness insurance policies, hospital or medical service plan contracts, and health maintenance organization health plan contracts shall be limited to those services certified by the insurance or health care plan carrier's physician, psychologist, licensed clinical social worker, marriage and family therapist, or advanced practice registered nurse as medically or psychologically necessary at the least restrictive appropriate level of care."

     SECTION 3.  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 to a physician, psychologist, licensed clinical social worker, marriage and family therapist, 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.  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, 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).  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, 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 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); 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, marriage and family therapist, 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, or advanced practice registered nurse and must be reasonably expected to improve the patient's condition.  An individualized treatment plan approved by a marriage and family therapist, 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;

     (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);

     (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); 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)."

     SECTION 4.  New statutory material is underscored.

     SECTION 5.  This Act shall take effect upon its approval.

 

INTRODUCED BY:

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