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HOUSE OF REPRESENTATIVES |
H.B. NO. |
2522 |
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TWENTY-SEVENTH LEGISLATURE, 2014 |
H.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The rate of children with orofacial anomalies such as a cleft lip or cleft palate in the State is estimated to be one in five hundred births. Orthodontic services for the treatment of orofacial anomalies are not included as a benefit in commercial health plans. Without orthodontic treatment, appropriate care and reconstructive surgical outcomes are compromised and this has resulted in functional deficiencies in chewing, swallowing, respiration, and speech, unstable or malpositioned oral structures, premature tooth loss, and adverse psychosocial effects.
Orthodontic services have for several years been a covered medical benefit of the Hawaii medicaid program and are a part of the benchmark plan for pediatric oral health for the essential health benefits package for the State.
Requiring insurance coverage for medically necessary orthodontic treatment of orofacial anomalies will enable individuals to obtain treatment and proceed with reconstructive surgery. However, the legislature recognizes that before statutorily mandating this coverage, it is necessary to obtain an assessment of the effects of this mandated coverage.
The purpose of this Act is to require the auditor to assess the social and financial effects of proposed mandatory health insurance coverage for orthodontic services for the treatment of orofacial anomalies for individuals in the State who are under twenty-six years of age.
SECTION 2. (a) The auditor shall assess the social and financial effects of making health insurance coverage for medically necessary orthodontic services for the treatment of orofacial anomalies a mandatory benefit in all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2015. The mandatory benefit shall be limited to policyholders and covered individuals in the State who are under twenty-six years of age.
(b) The mandatory benefit shall cover treatment performed to:
(1) Correct or repair abnormal oral structures of the body including, but not limited to, teeth, jaw, and related oral structures;
(2) Ensure good health and adequate dental structures; and
(3) Improve function of the affected structures and systems;
provided that treatment shall not be denied on the basis that treatment is habilitative or non-restorative in nature.
(c) The mandatory benefit for orthodontic services for treatment of orofacial anomalies shall be subject to a maximum benefit amount of $5,000 per treatment phase, but not subject to limits on the number of visits to an orthodontist; provided that payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, or service other than orthodontic services shall not be applied toward any maximum benefit.
(d) As of January 1, 2016, to the extent that the mandatory benefit requires benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), the specific benefits that exceed the specified essential health benefits shall not be required of a qualified health plan when the plan is offered in this State through the Hawaii health insurance exchange by a health carrier. Nothing in this Act shall nullify the application of the mandatory benefit to plans offered outside the Hawaii health insurance exchange.
(e) The auditor shall submit a report on the assessment specified in this Act to the legislature no later than twenty days before the convening of the regular session of 2015, and shall include findings, recommendations, and any implementing legislation.
SECTION 3. This Act shall take effect on July 1, 2050.
Report Title:
Mandatory Insurance Coverage; Orthodontic Treatment; Orofacial Anomalies; Auditor Assessment
Description:
Requires the Auditor to assess the social and financial impact of mandatory health insurance coverage for orthodontic services for the treatment of orofacial anomalies for individuals in the State who are under 26 years of age. Effective July 1, 2050. (HB2522 HD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.