SB2025

SECTION 1. The legislature finds that homelessness continues to be one of the State's most significant and challenging social problems. According to the 2017 Hawaii statewide homeless point-in-time conducted in January 2017, there are 7,220 homeless individuals in the State. Homeless persons face a myriad of issues, including general health care, mental illness, substance abuse, loss of employment and income, and a lack of affordable housing.

The legislature further finds that many people who experience homelessness have high health care needs and costs. In fact, a recent internal study by a major Hawaii insurer found that over half of the State's $2,000,000,000 medicaid allotment was consumed by a tiny fraction of individuals, many of whom are dealing with homelessness, mental illness, and substance addiction. For many of these individuals with complex health conditions, housing instability can be a significant barrier to regular health care access, which results in excessive use of expensive emergency department, inpatient treatment, and crisis services. A study by the Center for Outcomes Research and Education found that affordable housing reduced overall health care expenditures by twelve per cent for medicaid recipients. This savings in medicaid expenditures resulted from an eighteen per cent decrease in costly emergency department visits and a twenty per cent increase in less costly primary care services. By recognizing the importance of housing stability within the practice of health care for homeless individuals and exploring creative and innovative solutions to address homeless individuals' health care needs through housing stability from traditional and non-traditional resources, the State may be able to recover hundreds of millions of dollars a year.

Because of the significant connection between homelessness and health, the legislature finds and declares that homelessness is a medical condition and believes that homelessness should be treated similarly to other medical conditions.

The purpose of this Act is to:

(1) Beginning January 1, 2019, require all health plans in the State, including Hawaii employer-union health benefits trust fund health plans and medicaid managed care programs, to provide coverage for the treatment of homelessness; and

(2) Require the department of human services to seek a section 1115 waiver to amend the state medicaid plan to include housing and supportive housing services for chronically homeless individuals.

SECTION 2. 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- Homelessness; benefits and coverage; homeless individuals. (a) Each individual or group accident and health or sickness insurance policy issued or renewed in this State after January 1, 2019, shall provide to the policyholder coverage for the treatment of homelessness.

(b) This section shall not apply to disability, accident-only, medicare, medicare supplement, student accident and health or sickness insurance, dental-only, and vision-only policies or policies or renewals of six months or less.

(c) Every insurer shall provide written 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 calendar year 2019 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2019.

(d) Coverage for the treatment of homelessness under this section shall be subject to a maximum benefit of $ per year. This section shall not be construed as limiting benefits that are otherwise available to an individual under an accident and health or sickness insurance policy. Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, or service other than treatment of homelessness shall not be applied toward the maximum benefit established under this subsection.

(e) Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of an accident and health or sickness insurance policy that are no less favorable than the copayment, deductible, and coinsurance provisions for substantially all medical services covered by the policy.

(f) Treatment for homelessness shall include a treatment plan. Except for inpatient services, if an individual is receiving treatment for homelessness, an insurer may request a review of the treatment plan for continued authorization of coverage for treatment of homelessness at the insurer's discretion.

(g) The medical necessity of treatment covered by this section shall be determined pursuant to the policy and shall be defined in the policy in a manner that is consistent with other services under the policy. Except for inpatient services, if an individual is receiving treatment for homelessness, an insurer may request a review of the medical necessity of that treatment at the insurer's discretion.

(h) This section shall not be construed as reducing any obligation to provide services to an individual under any publicly funded program, an individualized family service plan, an individualized education program, or an individualized service plan.

(i) As used in this section, unless the context clearly requires otherwise:

"Homeless individual" has the same meaning as defined in section 334-1.

"Treatment" or "treatment for homelessness" includes the following care prescribed or ordered for a homeless individual by a licensed physician if the care is determined to be medically necessary:

(1) Behavioral health services, including mental health and substance abuse services;

(2) Case management;

(3) Personal care and personal assistance services; and

(4) Home and community-based services."

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- Homelessness; benefits and coverage; homeless individuals. (a) Each hospital and medical service plan contract issued or renewed in this State after January 1, 2019, shall provide to the member covered under the plan contract coverage for the treatment of homelessness.

(c) Every mutual benefit society shall provide written 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 calendar year 2019 when annual information is made available to members or in any other mailing to members, but in no case later than December 31, 2019.

(d) Coverage for the treatment of homelessness under this section shall be subject to a maximum benefit of $ per year. This section shall not be construed as limiting benefits that are otherwise available to a member under a hospital and medical service plan contract. Payments made by a mutual benefit society on behalf of a member for any care, treatment, intervention, or service other than treatment of homelessness shall not be applied toward the maximum benefit established under this subsection.

(e) Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of a hospital and medical service plan contract that are no less favorable than the copayment, deductible, and coinsurance provisions for substantially all medical services covered by the plan contract.

(f) Treatment for homelessness shall include a treatment plan. Except for inpatient services, if an individual is receiving treatment for homelessness, a mutual benefit society may request a review of the treatment plan for continued authorization of coverage for treatment of homelessness at the mutual benefit society's discretion.

(g) The medical necessity of treatment covered by this section shall be determined pursuant to the plan contract and shall be defined in the plan contract in a manner that is consistent with other services under the plan contract. Except for inpatient services, if an individual is receiving treatment for homelessness, a mutual benefit society may request a review of the medical necessity of that treatment at the society's discretion.

(i) As used in this section, unless the context clearly requires otherwise:

"Homeless individual" has the same meaning as defined in section 334-1.

"Treatment" or "treatment for homelessness" includes the following care prescribed or ordered for a homeless individual by a licensed physician if the care is determined to be medically necessary:

(1) Behavioral health services, including mental health and substance abuse services;

(2) Case management;

(3) Personal care and personal assistance services; and

(4) Home and community-based services."

SECTION 4. 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-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [~~431:10A-134,~~] 431:10A- , and chapter 431M."

SECTION 5. The department of human services shall seek a waiver pursuant to section 1115 of the Social Security Act, title 42 United States Code section 1315, and other approvals from the Centers for Medicare and Medicaid Services that may be necessary to amend the state medicaid plan to include housing and supportive housing services for medicaid eligible individuals, especially individuals experiencing chronic homelessness.

SECTION 6. The coverage and benefit for the treatment of homelessness to be provided by a health maintenance organization under section 4 of this Act shall apply to all policies, contracts, plans, or agreements issued or renewed in this State by a health maintenance organization after January 1, 2019.

SECTION 7. The mandatory coverage and treatment for homelessness required by this Act shall apply to:

(1) All health benefits plans under chapter 87A, Hawaii Revised Statutes, issued, renewed, modified, altered, or amended on or after January 1, 2019; and

(2) All plans under medicaid managed care programs in the State.

SECTION 8. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 9. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 10. This Act shall take effect on July 1, 2018; provided further that paragraph (2) of section 7 shall take effect upon approval of the 1115 waiver by the Centers for Medicare and Medicaid Services submitted pursuant to section 5 of this Act.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2025
TWENTY-NINTH LEGISLATURE, 2018
STATE OF HAWAII