REPORT TITLE:
Medical Directors; Licensure

DESCRIPTION:
Requires that medical directors of managed care health plans be
licensed to practice medicine in Hawaii. (HB325 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        325
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH.



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

 1      SECTION 1.  The legislature finds and declares that medical
 
 2 necessity decisions are clinical decisions and should be made by
 
 3 physicians who have a medical license to practice in the state
 
 4 where the patient care occurs.  The medical director of any
 
 5 managed care health plan, in making these medical necessity
 
 6 decisions, should therefore be subject to the same oversight by
 
 7 the Hawaii board of medical examiners or board of osteopathic
 
 8 examiners, and the same medical malpractice liability, as is an
 
 9 individual practicing physician.
 
10      The purpose of this Act is to require that medical directors
 
11 of managed care plans be licensed to practice medicine in Hawaii.
 
12      SECTION 2.  Chapter 432E, Hawaii Revised Statutes, is
 
13 amended by adding a new section to be appropriately designated
 
14 and to read as follows:
 
15      "�432E-     Licensure of managed care plan medical
 
16 directors.  The medical director of any managed care plan
 
17 providing services in the State shall hold an unlimited license
 
18 to practice medicine in the State pursuant to chapter 453 or
 
19 460."
 

 
Page 2                                                     325
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1      SECTION 3.  Section 432E-1, Hawaii Revised Statutes, is
 
 2 amended by adding a new definition to be appropriately inserted
 
 3 and to read as follows:
 
 4      ""Medical director" means the person who is authorized under
 
 5 a managed care plan and who makes decisions for the plan denying
 
 6 or allowing requests for medical treatments, services, or
 
 7 supplies based on medical necessity or other appropriate medical
 
 8 or health plan benefit standards."
 
 9      SECTION 4.  New statutory material is underscored.
 
10      SECTION 5.  This Act shall take effect         .