REPORT TITLE:
Substance Abuse Treatment


DESCRIPTION:
Removes the certification requirements for physicians providing
substance abuse treatment for insurance coverage purposes. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2773
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO INSURANCE. 


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

 1      SECTION 1.  Section 431M-1, Hawaii Revised Statutes, is
 
 2 amended by amending the definitions of "alcohol or drug
 
 3 dependence outpatient services", "certified substance abuse
 
 4 staff", "substance abuse services", and "treatment episode" to
 
 5 read as follows:
 
 6      ""Alcohol or drug dependence outpatient services" means
 
 7 specialized alcohol or drug dependence nonresidential treatment
 
 8 provided on an ambulatory basis to patients with alcohol or drug
 
 9 dependence problems that includes interventions prescribed and
 
10 performed by physicians, and psychologists, clinical social
 
11 workers, or advanced practice registered nurses who have been
 
12 certified pursuant to chapter 321.  This definition shall not
 
13 imply a broadening of the scope of or granting of prescriptive
 
14 authority privileges, except as otherwise allowed pursuant to
 
15 chapter 457.
 
16      "Certified substance abuse staff" means professionals and
 
17 paraprofessionals with current full certification as substance
 
18 abuse counselors or program administrators under chapter 321[,
 
19 physicians who hold a current American Society of Addiction
 

 
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 1 Medicine certificate or who are board certified in addiction
 
 2 psychiatry,] and psychologists who hold a current certification
 
 3 from the American Psychological Association College of
 
 4 Professional Psychology in the treatment of alcohol and other
 
 5 psychoactive substance use disorders.
 
 6      "Substance abuse services" means the provision of medical,
 
 7 psychological, nursing, counseling, or therapeutic services in
 
 8 response to a treatment plan for alcohol or drug dependence or
 
 9 both which shall include, when appropriate, a combination of
 
10 aftercare and individual, group and family counseling services
 
11 provided by physicians and certified substance abuse staff.
 
12      "Treatment episode" means one admission to an accredited
 
13 hospital or nonhospital facility, [or] office of a physician, or
 
14 office of a psychologist, clinical social worker, or advanced
 
15 practice registered nurse certified pursuant to chapter 321 for
 
16 treatment of alcohol or drug dependence, or both, as stipulated
 
17 in a prescribed treatment plan and which would generally produce
 
18 remission in those who complete the treatment.  The prescribed
 
19 treatment plan may include the provision of substance abuse
 
20 services in more than one location and may include in-hospital,
 
21 nonhospital residential, day treatment, or alcohol or drug
 
22 dependence outpatient services, or any combination thereof.  An
 
23 admission for only detoxification services shall not constitute a
 

 
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 1 treatment episode."
 
 2      SECTION 2.  Section 431M-4, Hawaii Revised Statutes, is
 
 3 amended to read as follows:
 
 4      "§431M-4 Mental illness, alcohol and drug dependence
 
 5 benefits. (a)  The covered benefit under this chapter shall not
 
 6 be less than thirty days of in-hospital services per year.  Each
 
 7 day of in-hospital services may be exchanged for two days of
 
 8 nonhospital residential services, two days of partial
 
 9 hospitalization services, or two days of day treatment services.
 
10 Visits to a physician, psychologist, clinical social worker, or
 
11 advanced practice registered nurse with a psychiatric or mental
 
12 health specialty or subspecialty shall not be less than thirty
 
13 visits per year to hospital or nonhospital facilities or to
 
14 mental health outpatient facilities for day treatment or partial
 
15 hospitalization services.  Each day of in-hospital services may
 
16 also be exchanged for two outpatient visits under this chapter;
 
17 provided that the patient's condition is such that the outpatient
 
18 services would reasonably preclude hospitalization.  The total
 
19 covered benefit for outpatient services in subsections (b) and
 
20 (c) shall not be less than twenty-four visits per year; provided
 
21 that coverage of twelve of the twenty-four outpatient visits
 
22 shall apply only to the services under subsection (c).  The other
 
23 covered benefits under this chapter shall apply to any of the
 

 
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 1 services in subsection (b) or (c).  In the case of alcohol and
 
 2 drug dependence benefits, the insurance policy may limit the
 
 3 number of treatment episodes but may not limit the number to less
 
 4 than two treatment episodes per lifetime.  Nothing in this
 
 5 section shall be construed to limit serious mental illness
 
 6 benefits.
 
 7      (b)  Alcohol and drug dependence benefits shall be as
 
 8 follows:
 
 9      (1)  Detoxification services as a covered benefit under this
 
10           chapter shall be provided either in a hospital or in a
 
11           nonhospital facility which has a written affiliation
 
12           agreement with a hospital for emergency, medical, and
 
13           mental health support services.  The following services
 
14           shall be covered under detoxification services:
 
15           (A)  Room and board;
 
16           (B)  Diagnostic x-rays;
 
17           (C)  Laboratory testing; and
 
18           (D)  Drugs, equipment use, special therapies, and
 
19                supplies.
 
20           Detoxification services shall be included as part of
 
21           the covered in-hospital services, but shall not be
 
22           included in the treatment episode limitation, as
 
23           specified in subsection (a);
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      (2)  Alcohol or drug dependence treatment through in-
 
 2           hospital, nonhospital residential, or day treatment
 
 3           substance abuse services as a covered benefit under
 
 4           this chapter shall be provided in a hospital or
 
 5           nonhospital facility.  Before a person qualifies to
 
 6           receive benefits under this subsection, a physician, or
 
 7           a psychologist, clinical social worker, or advanced
 
 8           practice registered nurse certified pursuant to
 
 9           chapter 321, shall determine that the person suffers
 
10           from alcohol or drug dependence, or both.  The
 
11           substance abuse services covered under this paragraph
 
12           shall include those services which are required for
 
13           licensure and accreditation, and shall be included as
 
14           part of the covered in-hospital services as specified
 
15           in subsection (a).  Excluded from alcohol or drug
 
16           dependence treatment under this subsection are
 
17           detoxification services and educational programs to
 
18           which drinking or drugged drivers are referred by the
 
19           judicial system, and services performed by mutual self-
 
20           help groups; and
 
21      (3)  Alcohol or drug dependence outpatient services as a
 
22           covered benefit under this chapter shall be provided
 
23           under an individualized treatment plan approved by a
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           physician, or a psychologist, clinical social worker,
 
 2           or advanced practice registered nurse certified
 
 3           pursuant to chapter 321, and must be reasonably
 
 4           expected to produce remission of the patient's
 
 5           condition.  An individualized treatment plan approved
 
 6           by a clinical social worker or an advanced practice
 
 7           registered nurse for a patient already under the care
 
 8           or treatment of a physician or psychologist shall be
 
 9           done in consultation with the physician or
 
10           psychologist.  Services covered under this paragraph
 
11           shall be included as part of the covered outpatient
 
12           services as specified in subsection (a).
 
13      (c)  Mental illness benefits.
 
14      (1)  Covered benefits for mental health services set forth
 
15           in this subsection shall be limited to coverage for
 
16           diagnosis and treatment of mental disorders.  All
 
17           mental health services shall be provided under an
 
18           individualized treatment plan approved by a physician,
 
19           psychologist, clinical social worker, or advanced
 
20           practice registered nurse with a psychiatric or mental
 
21           health specialty or subspecialty and must be reasonably
 
22           expected to improve the patient's condition.  An
 
23           individualized treatment plan approved by a clinical
 

 
Page 7                                                     2773
                                     H.B. NO.           
                                                        
                                                        

 
 1           social worker or an advanced practice registered nurse
 
 2           with a psychiatric or mental health specialty or
 
 3           subspecialty for a patient already under the care or
 
 4           treatment of a physician or psychologist shall be done
 
 5           in consultation with the physician or psychologist;
 
 6      (2)  In-hospital and nonhospital residential mental health
 
 7           services as a covered benefit under this chapter shall
 
 8           be provided in a hospital or a nonhospital residential
 
 9           facility.  The services to be covered shall include
 
10           those services required for licensure and
 
11           accreditation, and shall be included as part of the
 
12           covered in-hospital services as specified in subsection
 
13           (a);
 
14      (3)  Mental health partial hospitalization as a covered
 
15           benefit under this chapter shall be provided by a
 
16           hospital or a mental health outpatient facility.  The
 
17           services to be covered under this paragraph shall
 
18           include those services required for licensure and
 
19           accreditation and shall be included as part of the
 
20           covered in-hospital services as specified in subsection
 
21           (a); and
 
22      (4)  Mental health outpatient services shall be a covered
 
23           benefit under this chapter and shall be included as
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           part of the covered outpatient services as specified in
 
 2           subsection (a).
 
 3      (d)  This chapter shall apply to specialized alcohol and
 
 4 drug dependence services expected to produce remission of the
 
 5 patient's drug or alcohol dependent condition.  Nothing in this
 
 6 chapter shall be construed to prohibit licensed physicians from
 
 7 performing diagnostic evaluations, treating general medical
 
 8 complications of drug and alcohol abuse, and providing
 
 9 nonspecialized counseling and treatment as would occur in the
 
10 course of general medical practice or psychiatric treatment of
 
11 co-existing psychiatric conditions." 
 
12      SECTION 3.  Statutory material to be repealed is bracketed.
 
13 New statutory material is underscored.
 
14      SECTION 4.  This Act shall take effect upon its approval.
 
15 
 
16                       INTRODUCED BY:  ___________________________