Bill Text: HI HB1859 | 2016 | Regular Session | Introduced
Bill Title: Health Benefit Plans; Eating Disorders; Required Coverage
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Introduced - Dead) 2016-01-27 - Referred to HLT, CPC, referral sheet 2 [HB1859 Detail]
Download: Hawaii-2016-HB1859-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
1859 |
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TWENTY-EIGHTH LEGISLATURE, 2016 |
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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:
SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to part I of article 10A to be appropriately designated and to read as follows:
"§431:10A- Coverage for eating disorders. (a) Each individual or group accident and health or sickness insurance policy issued or renewed in this State after December 31, 2016, shall provide coverage for the diagnosis and treatment of eating disorders.
(b) Every insurer shall provide written 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 within calendar year 2017 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2017.
(c) Coverage provided under this section shall be limited to medically necessary treatment that is provided by a licensed treating physician, psychiatrist, psychologist, professional counselor, clinical social worker, or marital and family therapist pursuant to the powers granted under that person's license and acting within their applicable scope of coverage, in accordance with a treatment plan.
(d) The treatment plan under subsection (c), upon request by the insurer, shall include all elements necessary for the insurer to pay claims. Those elements include, but are not limited to, a diagnosis; proposed treatment by type, frequency, and duration of treatment; and goals.
(e) Coverage of the treatment of eating disorders may be subject to other general exclusions and limitations of the policy not in conflict with this section, including, but not limited to, the coordination of benefits, and utilization review of health care services, which includes reviews of medical necessity and care management. Medical necessity determinations and care management for the treatment of eating disorders shall consider the overall medical and mental health needs of the individual with an eating disorder, shall not be based solely on weight, and shall take into consideration the most recent Practice Guideline for the Treatment of Patients with Eating Disorders adopted by the American Psychiatric Association in addition to current standards based upon the medical literature generally recognized as authoritative in the medical community.
(f) As used in this section:
(1) "Eating disorder" includes pica, rumination disorder, avoidant or restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, any other specified feeding or eating disorder, and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association where diagnosed by a physician, psychiatrist, psychologist, clinical social worker, marital and family therapist, or professional counselor duly licensed in the state where that person practices;
(2) "Medical care" means health care services needed to diagnose, prevent, treat, cure, or relieve physical manifestations of an eating disorder, and shall include inpatient hospitalization, partial hospitalization, residential care, intensive outpatient treatment, follow-up outpatient care, and counseling;
(3) "Pharmacy care" means medications prescribed by a licensed physician for an eating disorder and includes any health-related services deemed medically necessary to determine the need or effectiveness of the medications, but only to the extent that the medications are included in the insurance policy;
(4) "Psychiatric care" and "psychological care" mean direct or consultative services provided during inpatient hospitalization, partial hospitalization, residential care, intensive outpatient treatment, follow-up outpatient care, and counseling provided by a psychiatrist or psychologist licensed in the state of practice;
(5) "Therapy" means medical care, pharmacy care, psychiatric care, psychological care, and behavioral interventions provided by a physician, psychiatrist, psychologist, professional counselor, licensed clinical social worker, or marital and family therapist, as applicable, where that person is licensed in the state where that person practices; and
(6) "Treatment of eating disorders" means therapy provided by a licensed treating physician, psychiatrist, psychologist, professional counselor, clinical social worker, or marital and family therapist pursuant to the powers granted under that person's license in the state where that person practices for an individual diagnosed with an eating disorder."
SECTION 2. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to part VI of article 1 to be appropriately designated and to read as follows:
"§432:1 Coverage for eating disorders. (a) Each individual or group hospital or medical service plan contract issued or renewed in this State after December 31, 2016, shall provide coverage for the diagnosis and treatment of eating disorders.
(b) Every mutual benefit society shall provide written 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 within calendar year 2017 when annual information is made available to members or in any other mailing to members, but in no case later than December 31, 2017.
(c) Coverage provided under this section shall be limited to medically necessary treatment that is provided by a licensed treating physician, psychiatrist, psychologist, professional counselor, clinical social worker, or marital and family therapist pursuant to the powers granted under that person's license and acting within their applicable scope of coverage, in accordance with a treatment plan.
(d) The treatment plan under subsection (c), upon request by the mutual benefit society, shall include all elements necessary for the mutual benefit society to pay claims. Those elements include, but are not limited to, a diagnosis; proposed treatment by type, frequency, and duration of treatment; and goals.
(e) Coverage of the treatment of eating disorders may be subject to other general exclusions and limitations of the plan contract not in conflict with this section, including, but not limited to, the coordination of benefits, and utilization review of health care services, which includes reviews of medical necessity and care management. Medical necessity determinations and care management for the treatment of eating disorders shall consider the overall medical and mental health needs of the individual with an eating disorder, shall not be based solely on weight, and shall take into consideration the most recent Practice Guideline for the Treatment of Patients with Eating Disorders adopted by the American Psychiatric Association in addition to current standards based upon the medical literature generally recognized as authoritative in the medical community.
(f) As used in this section:
(1) "Eating disorder" includes pica, rumination disorder, avoidant or restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, any other specified feeding or eating disorder, and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association where diagnosed by a physician, psychiatrist, psychologist, clinical social worker, marital and family therapist, or professional counselor duly licensed in the state where that person practices;
(2) "Medical care" means health care services needed to diagnose, prevent, treat, cure, or relieve physical manifestations of an eating disorder, and shall include inpatient hospitalization, partial hospitalization, residential care, intensive outpatient treatment, follow-up outpatient care, and counseling;
(3) "Pharmacy care" means medications prescribed by a licensed physician for an eating disorder and includes any health-related services deemed medically necessary to determine the need or effectiveness of the medications, but only to the extent that the medications are included in the plan contract;
(4) "Psychiatric care" and "psychological care" mean direct or consultative services provided during inpatient hospitalization, partial hospitalization, residential care, intensive outpatient treatment, follow-up outpatient care, and counseling provided by a psychiatrist or psychologist licensed in the state of practice;
(5) "Therapy" means medical care, pharmacy care, psychiatric care, psychological care, and behavioral interventions provided by a physician, psychiatrist, psychologist, professional counselor, licensed clinical social worker, or marital and family therapist, as applicable, where that person is licensed in the state where that person practices; and
(6) "Treatment of eating disorders" means therapy provided by a licensed treating physician, psychiatrist, psychologist, professional counselor, clinical social worker, or marital and family therapist pursuant to the powers granted under that person's license in the state where that person practices for an individual diagnosed with an eating disorder."
SECTION 3. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
"§432D-23 Required provisions and
benefits. Notwithstanding any provision of law to the contrary, each
policy, contract, plan, or agreement issued in the State after January 1, 1995,
by health maintenance organizations pursuant to this chapter, shall include
benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5,
431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119,
431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132,
431:10A-133, [and] 431:10A-140, and 431:10A- , and chapter
431M."
SECTION 4. Notwithstanding section 432D-23, Hawaii Revised Statutes, the coverage and benefits to be provided by a health maintenance organization under section 3 of this Act shall begin for all policies, contracts, plans, or agreements issued or renewed in this State by a health maintenance organization after December 31, 2016.
SECTION 5. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 7. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Health Benefit Plans; Eating Disorders; Required Coverage
Description:
Requires health benefit plans to provide coverage for eating disorders.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
