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Legislation Signed into Law

2016

SB 2854/HB 2325
Introduced: 1/2016
Sponsor: Sens. Kouchi and Rep. Souki
Status: Signed into Law 6/2016
Summary: Among other things, this bill amends state insurance law to include licensed dietitians treating eating disorders as professionals under covered benefits for mental health services.

2015

Primary Focus: Mandated Benefit
Title/Description: Autism benefits and coverage
Citation: Haw. Rev. Stat. § 431:10A-133; Haw. Rev. Stat. § 432:1-614
Summary: Each individual or group accident and health or sickness insurance policy issued or renewed in this State after January 1, 2016, shall provide to the policyholder and individuals under fourteen years of age covered under the policy coverage for the diagnosis and treatment of autism. 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. The above likewise applies to policies issued by Mutual Benefit Societies.
Effective Date: July 1, 2015
Notes: Enacted by Hi. SB 791.

2014

Primary Focus: Mandated Benefit
Title/Description: Mental illness, alcohol and drug dependence benefits
Citation: Haw. Rev. Stat. § 431M-4
Summary: Sets forth the parameters and limitations of mental health and alcohol and substance use disorder treatment insurance benefits. For example, all mental health services must be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, marriage and family therapist, licensed mental health counselor, advanced practice registered nurse, or licensed dietitian treating eating disorders, and must be reasonably expected to improve the patient’s condition.
Effective Date: July 1, 2014
Notes: Amended by Hi. SB 2820.

Primary Focus: Parity- General
Title/Description: Policy coverage.
Citation: Haw. Rev. Stat. § 431M-2
Summary: This statute was amended to substitute “alcohol use disorder, substance use disorder, and mental health treatment services, including services” for “alcohol dependence and drug dependence for alcohol dependence, drug dependence, and mental illness treatment services.” Additionally, language was added to prohibit financial requirements or treatment limitations on mental health or substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations, either quantitative or nonquantitative, imposed on medical and surgical benefits in accordance with MHPAEA.
Effective Date: July 1, 2014.
Notes: Amended by Hi. SB 2820.

SB 2054
Introduced: 1/2014
Sponsor: Sens. Green, Chun, Oakland, Ruderman
Status: Signed into Law 7/2014
Summary: This bill required the Insurance Commissioner to file a report about the ramifications of requiring insurance plans to cover autism services.

Hawaii Parity Law

There are several sections of the state insurance law relevant to parity. There are a few sections about behavioral health coverage, there are a few sections about behavioral health utilization review agents, and there are a few about autism coverage. These will be summarized in 3 sections:

  • Behavioral Health Coverage
  • Behavioral Health Utilization Review Agents
  • Autism Coverage

Behavioral Health Coverage

This section requires individual plans, small employer fully-insured plans, large employer fully-insured plans to cover behavioral health conditions, with no exclusions listed. Plans are forbidden from using any financial requirements, quantitative treatment limitations, and non-quantitative treatment limitations for behavioral health services that are “more restrictive” than those in place for other medical services. It explicitly requires plans to comply with the Federal Parity Law.

This section requires the following for substance use disorder services and mental health services:

This section requires the Insurance Commissioner to issue regulations regarding the linked sections above, and this section defines many terms related to behavioral health. It also requires these regulations to specifically address medical necessity criteria for behavioral health coverage.

Behavioral Health Utilization Review Agents

This section lists a number of requirements for utilization review agents who perform behavioral health service reviews. Some of the most significant requirements for these agents are:

  • Must disclose review criteria to patients and providers
  • Cannot deny or limit coverage for medical necessity without first consulting with another similarly-qualified professional
  • Written explanations about why coverage was denied
  • Instructions as to how the patient can start the appeals process
  • Agents must be “accessible” to patients and providers at least 5 days a week
  • Agents are forbidden from having contracts with plans or other payors that could be interpreted as a “conflict of interest”

This section requires an annual report to be filed detailing complaints against behavioral health review agents.

This section defines some of the terms in the section of the law about behavioral health utilization review agents.

Autism Coverage

The link to the section of the law is actually a link to the passed legislation from 2015 that added that section of the law because Hawaii’s online statutes page has not yet been updated to include this section.

This section requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover autism services through age 13.

There is a $25,000 annual maximum for applied behavior analysis (can be adjusted for inflation), but plans are not allowed to limit outpatient visits in any other way.

Financial requirements for autism services must be the same as those used for other medical services.

Plans can review a child’s treatment plan and perform medical necessity reviews as often as they want.

Plans can require that any child who was diagnosed with autism according to criteria in an earlier version of the DSM can be reevaluated to see if he or she meets the diagnostic criteria for autism in the current version of the DSM.

Autism is defined as the autism spectrum disorder from the DSM.

Autism treatment is listed as (these are all defined in the law):

  • Behavioral health treatment (includes applied behavior analysis)
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care

Get Support

Hawaii Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

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