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.
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.
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.
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:
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.
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.
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.
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)
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