Report Title:
Asthma
Description:
Establishes standards for the prevention, diagnosis, and treatment of asthma.
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
134 |
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TWENTY-THIRD LEGISLATURE, 2005 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
Relating to asthma.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Asthma is a serious disease that is growing in prevalence in Hawaii. An estimated one hundred six thousand residents of the State suffer from asthma. Recently, there has been a general trend of increased deaths from the disease. Asthma is most common during childhood and accounts for school absenteeism more than any other chronic condition.
While asthma is found among all populations, prevalence rates disproportionately affect low-income and minority populations. Untreated asthma affects worker productivity and results in unnecessary absences from work. In many cases, asthma triggers present in substandard housing and poorly ventilated workplaces contribute directly to asthma.
Although research continues into the causes and cures for asthma, national consensus has been reached on treatment guidelines. People with asthma treated in accordance with established guidelines are far more likely to control the disease than those not treated, less likely to experience debilitating or life-threatening asthma episodes, less likely to be hospitalized, and less likely to need to curtail normal school or work activities. With treatment, most people with asthma are able to live normal, active lives.
Up to one-third of people with asthma have not had their disease diagnosed. Among those with diagnosed asthma, thirty to fifty per cent are not receiving medicines that are needed to control the disease, and approximately eighty per cent of diagnosed asthmatics are not getting yearly spirometry measurements that are a key element in monitoring the disease.
SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§321- Asthma policy; heating and ventilation systems standards. (a) It is the policy of the State to institute heating and ventilation systems standards to prevent asthma by minimizing the presence of common asthma triggers such as dust mites and animal dander in recirculated air.
(b) All newly constructed residential buildings shall include standards for indoor air quality pollutant source control.
(c) The department of health shall establish requirements for the maintenance of indoor air quality in newly constructed residences as pertaining to asthma related triggers."
SECTION 3. Chapter 302A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§302A- Asthma policy. (a) The department of education, with the assistance of the department of health, shall develop a uniform policy for all schools by providing in-service training for school staff on:
(1) The symptoms, prevention, and treatment of asthma;
(2) Monitoring students with asthma; and
(3) Additional observations of students;
when needs arise during the school day and during school-sponsored events.
(b) The department of education's asthma policy shall include standards and skills for in-service training of school staff.
(c) All departmental school districts and school complexes shall adopt policies regarding asthma rescue procedures and asthma prevention policies for each school within the district."
SECTION 4. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- Med-QUEST; required provisions and benefits. (a) Med-QUEST benefits shall be expanded to provide asthma management services, including the development of individual asthma management plans.
(b) The department of human services, through the Med-QUEST program, shall provide benefits for at least the following services and supplies for persons with asthma:
(1) Relating to pharmacy services, appropriate and medically necessary equipment and supplies, as prescribed by a health care provider that shall include, but is not limited to:
(A) Asthma controller medicines;
(B) Coverings for mattresses and pillows for sensitive populations; and
(C) Smoking cessation services and medications for persons with asthma or others living in the same household.
(2) Outpatient self-management training and education, including development of an asthma plan and services of a certified asthma educator, as ordered by the health care provider. Asthma outpatient self-management training and education may be provided only by certified asthma educators.
(c) Nothing in this section prevents the health care service contractor from restricting patients to seeing only health care providers who have signed participating provider agreements with a health care service contractor or an insuring entity under contract with the health care service contractor.
(d) Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.
(e) Health care coverage may not be reduced or eliminated due to this section.
(f) Services required under this section shall be covered when deemed medically necessary by a licensed health care provider with the appropriate training and education in the pathophysiology, treatment, and education required for asthma management.
(g) For the purposes of this section, the following definitions shall apply:
"Health care provider" means a health care provider as defined in section 323D-2.
"Person with asthma" means a person diagnosed by a health care provider as having asthma."
SECTION 5. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:
"§431:10A- Asthma services; notice. (a) Any other law to the contrary notwithstanding, each employer group health policy, contract, plan, or agreement issued or renewed in this State after December 31, 2005, shall provide, not as an employer option, asthma services for the policyholder and individuals covered under the policy, contract, plan, or agreement. The asthma services shall provide at least the following:
(1) Relating to pharmacy services, appropriate and medically necessary equipment and supplies, as prescribed by a health care provider, that shall include, but is not limited to:
(A) Asthma controller medicines;
(B) Asthma rescue medicines;
(C) Peak flow meters;
(D) Spacers;
(E) Coverings for mattresses and pillows for sensitive populations;
(F) Smoking cessation services and medications for persons with asthma or others living in the same household, as prescribed by a health care provider; and
(G) Outpatient self-management and education, including development of an asthma plan and services of a certified asthma educator as ordered by the health care provider. The asthma outpatient self-management training and education may be provided only by certified asthma educators.
(b) Nothing in this section prevents the health care service contractor from restricting patients to seeing only health care providers who have signed participating provider agreements with the health care contractor or an insuring entity under contract with the health care service contractor.
(c) Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.
(d) Health care coverage may not be reduced or eliminated due to this section.
(e) Services required under this section shall be covered when deemed medically necessary by the medical director or a licensed health care provider with the appropriate training and education in the pathophysiology, treatment, and education required for asthma management and is subject to any referral and formulary requirements.
(f) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within the calendar year 2005 when annual information is made available to policyholders, or in any other mailing to policyholders, but in no case later than December 31, 2005.
(g) For the purposes of this section, the following definitions shall apply:
"Health care provider" means a health care provider as defined in section 323D-2.
"Person with asthma" means a person diagnosed by a health care provider as having asthma."
SECTION 6. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:
"§432:1- Asthma services; notice. (a) Any other law to the contrary withstanding, each individual and group hospital or medical service plan, policy, contract, or agreement issued or renewed in this State after December 31, 2005, shall provide, not as an employer option, asthma services for the member and individuals covered under the service plan, policy, contract, or agreement. The asthma services shall provide at least the following services and supplies:
(1) Relating to pharmacy services, appropriate and medically necessary equipment and supplies, as prescribed by a health care provider, that shall include, but is not limited to:
(A) Asthma controller medicines;
(B) Asthma rescue medicines;
(C) Peak flow meters;
(D) Spacers;
(E) Coverings for mattresses and pillows for sensitive populations;
(F) Smoking cessation services and medications for persons with asthma or others living in the same household, as prescribed by a health care provider; and
(G) Outpatient self-management and education, including development of an asthma plan and services of a certified asthma educator as ordered by the health care provider. The asthma outpatient self-management training and education may be provided only by certified asthma educators.
(b) Nothing in this section prevents the health care service contractor from restricting patients to seeing only health care providers who have signed participating provider agreements with the health care contractor or an insuring entity under contract with the health care service contractor.
(c) Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.
(d) Health care coverage may not be reduced or eliminated due to this section.
(e) Services required under this section shall be covered when deemed medically necessary by the medical director or a licensed health care provider with the appropriate training and education in the pathophysiology, treatment, and education required for asthma management and is subject to any referral and formulary requirements.
(f) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members within the calendar year 2005 when annual information is made available to policyholders, or in any other mailing to members, but in no case later than December 31, 2005.
(g) For the purposes of this section, the following definitions shall apply:
"Health care provider" means a health care provider as defined in section 323D-2.
"Person with asthma" means a person diagnosed by a health care provider as having asthma."
SECTION 7. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, [and] 431:10A-121, and 431:10A- , and chapter 431M."
SECTION 8. (a) The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A- , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 7 of this Act, shall take effect for all policies, contracts, plans, or agreements issued in the State after December 31, 2005.
SECTION 9. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§321- Department of health; asthma policy. (a) The department of health shall be the administrator and authority concerning asthma services in the State.
(b) The department of health shall:
(1) Collect data regarding the prevalence of asthma;
(2) Identify variations in practices of treatment of asthma;
(3) Identify populations with disproportionate prevalence rates of asthma; and
(4) Describe successful strategies for the diagnosis, prevention, and treatment of asthma.
(c) The department of health shall establish a common asthma registry process for all providers of health care services purchased by the State.
(d) The department of health shall explore common strategies for disease management and demand management programs to include individual asthma management plans."
SECTION 10. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 11. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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