THE SENATE	S.B. NO.	513
TWENTY-SEVENTH LEGISLATURE, 2013
STATE OF HAWAII

A BILL FOR AN ACT

relating to mental health.

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

     SECTION 1.  The purpose of this Act is to:

     (1)  Specify that each day of in-patient hospital services may be exchanged for one day of outpatient mental health services, for a total covered benefit of thirty days per year for mental health services;

     (2)  Require the total covered benefits for mental health services to include up to twenty-four outpatient visits per year, as authorized by a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse; and

     (3)  Specify that if needed, an additional six covered visits may be used for outpatient mental health services; provided that coverage of the additional six visits shall require a medical necessity determination recommended by the treating licensed health care provider and approved by the health plan's medical director.

     SECTION 2.  Section 431M-4, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  The covered benefit under this chapter shall not be less than thirty days of in-hospital services per year.  Each day of in-hospital services may be exchanged for two days of nonhospital residential services, two days of partial hospitalization services, or two days of day treatment services.  Visits to a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse shall not be less than thirty visits per year to hospital or nonhospital facilities or to mental health outpatient facilities for day treatment or partial hospitalization services.  Each day of in-hospital services may also be exchanged for two outpatient visits under this chapter; provided that the patient's condition is such that the outpatient services would reasonably preclude hospitalization.  Each day of in-patient hospital services may be exchanged for one day of outpatient mental health services, for a total covered benefit of thirty days per year for mental health services.  The total covered benefit for mental health services shall include up to twenty-four outpatient visits per year, as authorized by a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse.  If needed, an additional six covered visits may be used for outpatient mental health services; provided that coverage of the additional six visits shall require a medical necessity determination pursuant to section 432E-1.4.  The total covered benefit for outpatient services in [subsections] subsection (b) [and (c)] shall not be less than twenty-four visits per year[; provided that coverage of twelve of the twenty-four outpatient visits shall apply only to the services under subsection (c)].  The other covered benefits under this chapter shall apply to any of the services in subsection (b) or (c).  In the case of alcohol and drug dependence benefits, the insurance policy may limit the number of treatment episodes but may not limit the number to less than two treatment episodes per lifetime.  Nothing in this section shall be construed to limit serious mental illness benefits."

     SECTION 3.  Section 432E-1.4, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  For contractual purposes, a health intervention shall be covered if it is an otherwise covered category of service, not specifically excluded, recommended by the treating licensed health care provider, and determined by the health plan's medical director to be medically necessary as defined in subsection (b).  For purposes of outpatient mental health benefits under section 431M-4(c), the total covered benefit shall include up to twenty-four outpatient visits per year, as authorized by a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse; provided that if needed, an additional six covered visits may be used for outpatient mental health services.  Coverage of the additional six visits shall require a medical necessity determination recommended by the treating licensed health care provider and approved by the health plan's medical director.  A health intervention may be medically indicated and not qualify as a covered benefit or meet the definition of medical necessity.  A managed care plan may choose to cover health interventions that do not meet the definition of medical necessity."

     SECTION 4.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 5.  This Act shall take effect upon its approval.

INTRODUCED BY:

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Report Title:

Mental Health; Mental Illness Benefits; Insurance

Description:

Specifies that each day of in-patient hospital services may be exchanged for one day of outpatient mental health services, for a total covered benefit of thirty days per year for mental health services.  Requires the total covered benefits for mental health services to include up to twenty-four authorized outpatient visits per year.  Specifies that if needed, an additional six covered visits may be used for outpatient mental health services; provided that coverage of the additional six visits shall require a medical necessity determination.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.