STAND. COM. REP. NO. 699

                                 Honolulu, Hawaii
                                                   , 1999

                                 RE: H.B. No. 326
                                     H.D. 1




Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Consumer Protection and Commerce, to which
was referred H.B. No. 326 entitled: 

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

begs leave to report as follows:

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

     Your Committee received testimony in favor of this measure
from the Director of Health and Kaiser Permanente, both of whom
offered amendments.  Testimony in opposition to the measure was
received from the American Council of Life Insurance.

     Your Committee finds that the Newborn Metabolic Screening
Program in Hawaii currently screens over ninety-nine per cent of
newborns for seven disorders including phenylketonuria and maple
syrup urine disease.  Without timely diagnosis and effective
treatment with medical foods and low-protein modified food
products, phenylketonuria and maple syrup urine disease culminate
in severe mental retardation or death.  Other complications
related to poor medical and dietary management include coma,
stroke, seizures, psychomotor delays, and metabolic crises.
There are currently twenty-two individuals with inherited
metabolic diseases in Hawaii who require low-protein modified
food products or medical foods to treat their disease.  Your

 
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Committee finds, however, that it is crucial that the State's
commitment to screening is accompanied by a commitment to
treatment of affected newborns that are discovered through
screening.

     Your Committee agrees with the intent of this measure, and
finds that as of January, 1999, twenty-one states have enacted
legislation relating to coverage of low-protein modified food
products or medical foods for individuals with inborn errors of
metabolism.  Your Committee finds that this bill is a cost-saving
measure that will help to ensure optimal treatment and improved
health outcomes among these individuals in Hawaii.

     Upon further consideration, your Committee has amended this
bill by:

     (1)  Changing the term "inherited metabolic disease" to
          "inborn error of metabolism", and amending the
          definition of that term to provide that the disease is
          one which is characterized by deficient metabolism
          originating from congenital defects or defects arising
          shortly after birth, of amino acid, organic acid,
          carbohydrate, or fat;

     (2)  Amending the definition of "low-protein modified food
          product" by providing that the food is one that is
          prescribed or ordered by a physician as medically
          necessary, rather than one that is intended to be used
          under the direction of a physician;

     (3)  Adding a third condition to the coverage of medical
          foods and low-protein modified food products such that
          the food or food product is "not a commonly available
          commercial preparation".  The concern of your Committee
          is that without this language, the bill might be
          interpreted to require health plans to pay for routine
          soy formulas or predigested formulas, which are
          generally available under the WIC program for families
          in need;

     (4)  Excluding life insurance, disability income insurance,
          and long-term care insurance from the bill's
          requirement that each policy of accident and sickness
          insurance issued or renewed in Hawaii contain a
          provision for coverage of medical foods and low-protein
          modified food products for the treatment of inborn
          error of metabolism; and

 
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     (5)  Making technical, nonsubstantive changes for the
          purposes of clarity and consistency.

     As affirmed by the record of votes of the members of your
Committee on Consumer Protection and Commerce that is attached to
this report, your Committee is in accord with the intent and
purpose of H.B. No. 326, as amended herein, and recommends that
it be referred to the Committee on Finance, in the form attached
hereto as H.B. No. 326, H.D. 1.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Consumer
                                   Protection and Commerce,



                                   ______________________________
                                   RON MENOR, Chair

 
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