REPORT TITLE:
Substance Abuse Parity



DESCRIPTION:
Requires parity in insurance coverage for substance abuse
services.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2974
THE SENATE                              S.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO SUBSTANCE ABUSE INSURANCE BENEFITS.



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

 1      SECTION 1.  Section 431M-2, Hawaii Revised Statutes, is
 
 2 amended to read as follows:
 
 3      "[[]431M-2[]]  Policy coverage.  All individual and group
 
 4 accident and sickness insurance policies issued in this State,
 
 5 individual or group hospital or medical service plan contracts,
 
 6 and nonprofit mutual benefit association and health maintenance
 
 7 organization health plan contracts shall include within their
 
 8 hospital and medical coverage the benefits [of] for alcohol
 
 9 dependence, drug dependence, and mental illness treatment
 
10 services provided in section 431M-4 except that this section
 
11 shall not apply to insurance policies that are issued solely for
 
12 single diseases, or otherwise limited, specialized coverage[.];
 
13 provided that benefits for substance abuse services shall cover
 
14 adults and children and be under the same terms and conditions as
 
15 coverage provided for other illnesses and diseases."
 
16      SECTION 2.  Section 431M-4, Hawaii Revised Statutes, is
 
17 amended as follows:
 
18      1.  By amending subsection (a) to read:
 
19      "(a)  The covered benefit under this chapter shall not be
 

 
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 1 less than thirty days of in-hospital services per year.  Each day
 
 2 of in-hospital services may be exchanged for two days of
 
 3 nonhospital residential services, two days of partial
 
 4 hospitalization services, or two days of day treatment services.
 
 5 Visits to a physician, psychologist, clinical social worker, or
 
 6 advanced practice registered nurse with a psychiatric or mental
 
 7 health specialty or subspecialty shall not be less than thirty
 
 8 visits per year to hospital or nonhospital facilities or to
 
 9 mental health outpatient facilities for day treatment or partial
 
10 hospitalization services.  Each day of in-hospital services may
 
11 also be exchanged for two outpatient visits under this
 
12 chapter;provided that the patient's condition is such that the
 
13 outpatient services would reasonably preclude hospitalization.
 
14 The total covered benefit for outpatient services in subsections
 
15 (b) and (c) shall not be less than twenty-four visits per year;
 
16 provided that coverage of twelve of the twenty-four outpatient
 
17 visits shall apply only to the services under subsection (c).
 
18 The other covered benefits under this chapter shall apply to any
 
19 of the services in subsection (b) or (c).  [In the case of
 
20 alcohol and drug dependence benefits, the insurance policy may
 
21 limit the number of treatment episodes but may not limit the
 
22 number to less than two treatment episodes per lifetime.]
 
23 Nothing in this section shall be construed to limit serious
 

 
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 1 mental illness benefits.
 
 2      2.  By amending subsection (c) to read:
 
 3      "(c)  Mental illness benefits.
 
 4      (1)  Covered benefits for mental health services set forth
 
 5           in this subsection shall be limited to coverage for
 
 6           diagnosis and treatment of mental disorders.  All
 
 7           mental health services shall be provided under an
 
 8           individualized treatment plan approved by a physician,
 
 9           psychologist, clinical social worker, or advanced
 
10           practice registered nurse with a psychiatric or mental
 
11           health specialty or subspecialty and must be reasonably
 
12           expected to improve the patient's condition.  An
 
13           individualized treatment plan approved by a clinical
 
14           social worker or an advanced practice registered nurse
 
15           with a psychiatric or mental health specialty or
 
16           subspecialty for a patient already under the care or
 
17           treatment of a physician or psychologist shall be done
 
18           in consultation with the physician or psychologist;
 
19      (2)  In-hospital and nonhospital residential mental health
 
20           services as a covered benefit under this chapter shall
 
21           be provided in a hospital or a nonhospital residential
 
22           facility.  The services to be covered shall include
 
23           those services required for licensure and
 

 
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 1           accreditation, and shall be included as part of the
 
 2           covered in-hospital services as specified in subsection
 
 3           (a);
 
 4      (3)  Mental health partial hospitalization as a covered
 
 5           benefit under this chapter shall be provided by a
 
 6           hospital or a mental health outpatient facility.  The
 
 7           services to be covered under this paragraph shall
 
 8           include those services required for licensure and
 
 9           accreditation and shall be included as part of the
 
10           covered in-hospital services as specified in subsection
 
11           (a); and
 
12      (4)  Mental health outpatient services shall be a covered
 
13           benefit under this chapter and shall be included as
 
14           part of the covered outpatient services as specified in
 
15           subsection (a).
 
16 Policy coverage under section 431M-2 shall not discriminate
 
17 against any person with an alcohol or drug dependence.  For
 
18 purposes of this section, discrimination means separate terms,
 
19 conditions, or requirements imposed for policy coverage under
 
20 section 431M-2 that are not imposed for other illnesses and
 
21 diseases, including but not limited to lifetime or annual plan
 
22 payment limits; deductibles, copayment, coinsurance, and other
 
23 cost-sharing requirements; out-of-pocket limits that are imposed
 

 
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 1 for physical health coverage; and benefit and service
 
 2 limitations, terms, conditions, and other practices for hospital
 
 3 inpatient, partial hospitalization, or outpatient treatment."
 
 4      SECTION 3.  Section 431M-5, Hawaii Revised Statutes, is
 
 5 amended by amending subsection (c) to read as follows:
 
 6      "(c)  A health insurance plan shall not impose rates, terms,
 
 7 or conditions including service limits and financial
 
 8 requirements, [on serious mental illness benefits,] for substance
 
 9 abuse services if similar rates, terms, or conditions are not
 
10 applied to services for other medical or surgical conditions.
 
11 This [subsection shall not] chapter shall apply to individual or
 
12 group hospital or medical service plan contracts, and nonprofit
 
13 mutual benefit association and health maintenance organization
 
14 health plan contracts providing coverage to employers with
 
15 twenty-five or fewer employees, [and] government employee health
 
16 benefits plans under chapter 87[;], and [provided further that
 
17 this subsection shall not apply to] QUEST medical plans under the
 
18 department of human services [until July 1, 2002]."
 
19      SECTION 4.  Statutory material to be repealed is bracketed.
 
20 New statutory material is underscored.
 
21      SECTION 5.  This Act shall take effect on July 1, 2002, and
 
22 shall apply to policies issued or renewed after December 31,
 
23 2002.
 
24 
 
25                       INTRODUCED BY:_____________________________