REPORT TITLE:
Substance Abuse Treatment


DESCRIPTION:
Allows physicians to provide substance abuse treatment for
insurance coverage purposes.  (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        3053
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO INSURANCE. 


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

 1      SECTION 1.  Chapter 431M, Hawaii Revised Statutes, is
 
 2 amended by adding a new section to be appropriately designated
 
 3 and to read as follows:
 
 4      "§431M-    Licensed physician services.  Nothing in this
 
 5 chapter shall be construed to prohibit physicians licensed under
 
 6 chapter 453 from:
 
 7      (1)  Performing medical or psychiatric evaluations;
 
 8      (2)  Treating general medical or psychiatric complications
 
 9           of drug and alcohol abuse; and
 
10      (3)  Providing medical supervision of detoxification
 
11           services,
 
12 as would occur in the course of general medical or psychiatric
 
13 practice." 
 
14      SECTION 2.  Section 431M-1, Hawaii Revised Statutes, is
 
15 amended by amending the definition of "treatment episode" to read
 
16 as follows:
 
17      ""Treatment episode" means one admission to an accredited
 
18 hospital or nonhospital facility, or office of a physician,
 
19 psychologist, clinical social worker, or advanced practice
 

 
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 1 registered nurse certified pursuant to chapter 321 for treatment
 
 2 of alcohol or drug dependence, or both, as stipulated in a
 
 3 prescribed treatment plan and which would generally produce
 
 4 remission in those who complete the treatment.  The prescribed
 
 5 treatment plan may include the provision of substance abuse
 
 6 services in more than one location and may include in-hospital,
 
 7 nonhospital residential, day treatment, or alcohol or drug
 
 8 dependence outpatient services, or any combination thereof.  An
 
 9 initial outpatient evaluation or admission for only
 
10 detoxification services shall not constitute a treatment
 
11 episode."
 
12      SECTION 3.  Section 431M-4, Hawaii Revised Statutes, is
 
13 amended by amending subsection (b) to read as follows:
 
14      "(b)  Alcohol and drug dependence benefits shall be as
 
15 follows:
 
16      (1)  Detoxification services as a covered benefit under this
 
17           chapter shall be provided either in a hospital or in a
 
18           nonhospital facility which has a written affiliation
 
19           agreement with a hospital for emergency, medical, and
 
20           mental health support services.  The following services
 
21           shall be covered under detoxification services:
 
22           (A)  Room and board;
 
23           (B)  Diagnostic x-rays;
 

 
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 1           (C)  Laboratory testing; [and]
 
 2           (D)  Drugs, equipment use, special therapies, and
 
 3                supplies[.]; and
 
 4           (E)  Physician services under section 431M-   .
 
 5           Detoxification services shall be included as part of
 
 6           the covered in-hospital services, but shall not be
 
 7           included in the treatment episode limitation, as
 
 8           specified in subsection (a);
 
 9      (2)  Alcohol or drug dependence treatment through
 
10           in-hospital, nonhospital residential, or day treatment
 
11           substance abuse services as a covered benefit under
 
12           this chapter shall be provided in a hospital or
 
13           nonhospital facility.  Before a person qualifies to
 
14           receive benefits under this subsection, a physician,
 
15           psychologist, clinical social worker, or advanced
 
16           practice registered nurse certified pursuant to
 
17           chapter 321 shall determine that the person suffers
 
18           from alcohol or drug dependence, or both.  The
 
19           substance abuse services covered under this paragraph
 
20           shall include those services which are required for
 
21           licensure and accreditation, and shall be included as
 
22           part of the covered in-hospital services as specified
 
23           in subsection (a).  Excluded from alcohol or drug
 

 
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 1           dependence treatment under this subsection are
 
 2           detoxification services and educational programs to
 
 3           which drinking or drugged drivers are referred by the
 
 4           judicial system, and services performed by mutual self-
 
 5           help groups; and
 
 6      (3)  Alcohol or drug dependence outpatient services as a
 
 7           covered benefit under this chapter shall be provided
 
 8           under an individualized treatment plan approved by a
 
 9           physician, psychologist, clinical social worker, or
 
10           advanced practice registered nurse certified pursuant
 
11           to chapter 321 and must be reasonably expected to
 
12           produce remission of the patient's condition.  An
 
13           individualized treatment plan approved by a clinical
 
14           social worker or an advanced practice registered nurse
 
15           for a patient already under the care or treatment of a
 
16           physician or psychologist shall be done in consultation
 
17           with the physician or psychologist.  Services covered
 
18           under this paragraph shall be included as part of the
 
19           covered outpatient services as specified in subsection
 
20           (a)." 
 
21      SECTION 4.  Statutory material to be repealed is bracketed.
 
22 New statutory material is underscored.
 
23      SECTION 5.  This Act shall take effect upon its approval.