STAND. COM. REP. NO. 1223

                                   Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.C.R. No. 152
                                        S.D. 1




Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Health and Human Services, to which was
referred S.C.R. No. 152 entitled:

     "SENATE CONCURRENT RESOLUTION REQUESTING THE HAWAII PATIENT
     BILL OF RIGHTS AND RESPONSIBILITIES TASK FORCE TO MAKE A
     THOROUGH STUDY OF THE ISSUES RELATING TO THE USE OF THE TERM
     "MEDICAL NECESSITY" TO DETERMINE THE MOST APPROPRIATE
     DEFINITION OF "MEDICAL NECESSITY," OR TO DEVELOP NEW TERMS
     TO BETTER RESOLVE THE ISSUES EXAMINED,"

begs leave to report as follows:

     The purpose of this measure is to request the Hawaii Patient
Bill of Rights and Responsibilities Task Force to make a thorough
study of the issues relating to the use of the term "medical
necessity" to determine the most appropriate definition of
"medical necessity", or to develop new terms to better resolve
the issues examined.

     Your Committee received testimony in support of this measure
from the Insurance Commissioner, Hawaii Medical Service
Association, Hawaii Medical Association, and Hawaii Insurers
Council.

     One of the most hotly-debated health care issues around the
country relates to the meaning and use of the term "medical
necessity", to the point where the term has become an
"essentially contestable" concept.  Competing definitions of
"medical necessity" have evolved, but there is still no universal
acceptance of any one definition, consensus in the literature on

 
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                                   STAND. COM. REP. NO. 1223
                                   Page 2


guidelines, or a national model.  Yet, many medical decisions on
treatment are based on a standard of medical necessity.  This
measure is intended to bring resolution of this issue to Hawaii,
including what is "medically necessary", who decides it, who
should be held accountable for it, and what evidence should be
required in determining it.

     Your Committee has amended this measure to include the
Hawaii Insurers Council in the study.

     As affirmed by the record of votes of the members of your
Committee on Health and Human Services that is attached to this
report, your Committee concurs with the intent and purpose of
S.C.R. No. 152, as amended herein, and recommends that it be
referred to the Committee on Commerce and Consumer Protection, in
the form attached hereto as S.C.R. No. 152, S.D. 1.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Health and Human
                                   Services,



                                   ______________________________
                                   SUZANNE CHUN OAKLAND, Chair

 
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