STAND. COM. REP. NO. 74-00

                                 Honolulu, Hawaii
                                                   , 2000

                                 RE: H.B. No. 2811
                                     H.D. 1




Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 2000
State of Hawaii

Sir:

     Your Committee on Health, to which was referred H.B. No.
2811 entitled: 

     "A BILL FOR AN ACT RELATING TO HEALTH,"

begs leave to report as follows:

     The purpose of this bill is protect patients in managed care
plans by:

     (1)  Establishing an expedited process for an appeal of a
          managed care plan's decision;

     (2)  Extending the time period to request an external review
          of a managed care plan's final determination; and

     (3)  Establishing standards for determining whether a health
          intervention is a "medical necessity".

     The Patient Rights and Responsibilities Task Force (Task
Force), Kaiser Permanente, the Hawaii Medical Services
Association, Kokua Council, and the Hawaii Psychiatric Medical
Association testified in support of this measure.  The Hawaii
Nurses' Association testified in support of the intent of this
measure.  The American Academy of Pediatrics (AAP), the Hawaii
Chapter of AAP (Hawaii AAP), and the Hawaii Psychological
Association opposed provisions relating to the definition of
"medical necessity".  The Department of Health, the Arc in
Hawaii, and the Hawaii Medical Association submitted comments.


 
 
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     This measure is the product of Act 137, Session Laws of
Hawaii (SLH) 1999, and S.C.R. No. 152, 1999, that requested the
Task Force to:

     (1)  Develop further legislation addressing issues within
          the scope of the Task Force's responsibilities under
          Act 178, SLH 1998; and

     (2)  Conduct a thorough study of the issues relating to the
          use of the term "medical necessity".

     Your Committee finds that the definition of "medical
necessity" raises concerns over the denial of prevention and
early intervention practices.  To be considered "medically
necessary", the health intervention must, among other things, be
able to treat a "medical condition", which is defined as, "a
disease, illness, injury, genetic or congenital defect,
pregnancy, or a biological or psychological condition that lies
outside the range of normal, age-appropriate human variation".
The Hawaii AAP testified that the definition of "medical
condition" is illness-oriented and does not include prevention
measures, such as immunizations, well-child care, and smoking
prevention.

     The Chair of the Task Force testified, however, that to
"treat" a medical condition is, by definition, and among other
things, prevention.  If the Chair of the Task Force is correct,
to be considered "medically necessary", a health intervention
must, among other things, prevent a disease, illness, injury,
genetic or congenital defect, pregnancy, or a biological or
psychological condition that lies outside the range of normal,
age-appropriate human variation.

     Your Committee addressed this issue in its deliberations,
but respectfully requests the Committee on Consumer Protection
and Commerce to examine even further whether prevention practices
are included in the scope of "medical necessity".

     Your Committee further finds that physicians are one of many
other licensed health care providers currently making health
intervention and treatment decisions for patients.  This measure
refers to only physicians, and as such, has been amended by:

     (1)  Using the term "licensed health care provider" in lieu
          of the term "physician" in certain provisions;

     (2)  Adding the definitions of "licensed health care
          provider" and "treating licensed health care provider"

 
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          to the Patients' Bill of Rights and Responsibilities
          Act (Chapter 432E, Hawaii Revised Statutes);

     (3)  Clarifying that a treating licensed health care
          provider and a treating physician may determine medical
          necessity; and

     (4)  Making technical, nonsubstantive amendments for
          purposes of clarity and style.

     As affirmed by the record of votes of the members of your
Committee on Health that is attached to this report, your
Committee is in accord with the intent and purpose of H.B. No.
2811, as amended herein, and recommends that it pass Second
Reading in the form attached hereto as H.B. No. 2811, H.D. 1, and
be referred to the Committee on Consumer Protection and Commerce.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Health,



                                   ______________________________
                                   ALEXANDER C. SANTIAGO, Chair