Allows a person entitled to benefits to choose a traditional, alternative, complementary or integrative licensed health care provider.

A BILL FOR AN ACT

SECTION 1. The legislature finds that patients should have access to alternative, complementary, and integrative forms of health care. Many, if not most, states require insurance plans to cover all licensed providers. Currently, the majority of health insurance policies cover only traditional, Western health care services. New and innovative as well as alternative medicine delivery systems are not covered under these policies. Patients have been demanding and purchasing traditional, alternative, complementary, and integrative healthcare services both directly from providers and through health care coverage choices. This is evidenced by the fact that spending for alternative medicine options has surpassed the gross national consumer spending for primary care physicians.

The purpose of this Act is to require prepaid health care policies to cover alternative, complementary, and integrative forms of health care services when performed by licensed providers.

SECTION 2. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§431:10A-   Alternative care by licensed providers. (a) All individual and group accident and health or sickness insurance policies issued in this State and individual or group hospital or medical service plan contracts shall cover services provided by licensed providers of alternative, complementary, and integrative health care; provided that:

(b) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any health care service, which is within the lawful scope of practice of the duly licensed health care provider, the person entitled to benefits or the person performing the service shall be entitled to reimbursement and the policy, contract, plan, or agreement that provides for reimbursement for any health care service shall include services by every category of provider including services performed by a traditional, alternative, complementary, or integrative health care provider and shall not discriminate based upon race, religion, national origin, ancestry, sex, sexual orientation, age, disability status or type of licensure.

(c) An insurer may require a health care provider to abide by standards promulgated by the insurer; provided that the standards shall not unreasonably exclude categories of health care providers.

(d) An insurer may place reasonable limits on the health care services rendered by health care providers; provided that the insurer shall not limit the type of health care provider who may render the service.

(e) An insurer offering a policy, contract, plan, or agreement with a restricted network may select the individual health care providers under written guidelines approved by the insurance commissioner and shall include every category of health care providers with whom the insurer will contract or provide reimbursement. The health care insurer shall seek to establish a reasonable number of providers, subject to review by the insurance commissioner, within the various geographic districts to provide a substantial number of providers to service ongoing health care needs of the consuming public.

(f) An insurer shall not offer coverage for health care services for certain categories of health care providers as a separately priced optional benefit.

(g) As used in this section, "licensed providers of alternative, complementary, and integrative health care," means acupuncturists licensed under chapter 436E, massage therapists licensed under chapter 452, naturopathic physicians licensed under chapter 455, and chiropractors licensed under chapter 442."

SECTION 3. 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-   Alternative care by licensed providers. All group health care contracts under this chapter shall provide, to the extent provided under section 431:10A-     , coverage for services provided by licensed practitioners of alternative, complementary, and integrative health care services."

SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 2 to be appropriately designated and to read as follows:

"§432:2-   Alternative care by licensed providers. All fraternal benefit societies under this chapter shall provide, to the extent provided under section 431:10A-     , coverage for services provided by licensed practitioners of alternative, complementary, and integrative health care services."

SECTION 5. 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-121,431: 10A___ and chapter 431M."

SECTION 6. This Act shall not require an auditor's study under section 23-51, Hawaii Revised Statutes.

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect on September 1, 2006.