Bill Text: HI SB122 | 2011 | Regular Session | Amended
Bill Title: Naturopathic Physician; Insurance
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Engrossed - Dead) 2011-03-10 - (H) Referred to HLT, CPC, FIN, referral sheet 33 [SB122 Detail]
Download: Hawaii-2011-SB122-Amended.html
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THE SENATE |
S.B. NO. |
122 |
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TWENTY-SIXTH LEGISLATURE, 2011 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to naturopathic physicians.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. 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- Coverage for services by a naturopathic physician. (a) Effective July 1, 2011, each policy of accident and health or sickness insurance delivered or issued for delivery in this State that includes a rider to provide coverage for complementary or alternative medicine shall provide coverage under the rider for services for purposes of health maintenance, diagnosis, or treatment provided by a naturopathic physician licensed pursuant to section 455 and practicing within the scope of licensure.
(b) The reimbursement rate for services provided pursuant to this section shall be the reimbursement rate for medical and rehabilitation benefits calculated pursuant to part II of chapter 386."
SECTION 2. 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- Coverage for services by a naturopathic physician. (a) Effective July 1, 2011, each policy of accident and health or sickness insurance delivered or issued for delivery in this State by a mutual benefit society that includes a rider to provide coverage for complementary or alternative medicine shall provide coverage under the rider for services for purposes of health maintenance, diagnosis, or treatment provided by a naturopathic physician licensed pursuant to section 455 and practicing within the scope of licensure.
(b) The reimbursement rate for services provided pursuant to this section shall be the reimbursement rate for medical and rehabilitation benefits calculated pursuant to part II of chapter 386."
SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 2, to be appropriately designated and to read as follows:
"§432:2- Coverage for services by a naturopathic physician. (a) Effective July 1, 2011, each policy of accident and health or sickness insurance delivered or issued for delivery in this State by a fraternal benefit society that includes a rider to provide coverage for complementary or alternative medicine shall provide coverage under the rider for services for purposes of health maintenance, diagnosis, or treatment provided by a naturopathic physician licensed pursuant to section 455 and practicing within the scope of licensure.
(b) The reimbursement rate for services provided pursuant to this section shall be the reimbursement rate for medical and rehabilitation benefits calculated pursuant to part II of chapter 386."
SECTION 4. Section 431:10A-115.5, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:
"(e) For the purposes of this section,
"child health supervision services" means [physician-delivered,
physician-supervised, physician assistant-delivered, or nurse-delivered
services as defined by section 457-2 ("registered nurse")] services
supervised by a physician or osteopathic physician licensed pursuant to chapter
453 or services delivered by a physician or osteopathic physician licensed
pursuant to chapter 453, a naturopathic physician licensed pursuant to chapter
455, or a registered nurse licensed pursuant to chapter 457 which shall
include as the minimum benefit coverage for services delivered at intervals and
scope stated in this section."
SECTION 5. Section 431:10A-116, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-116 Coverage for specific services. Every person insured under a policy of accident and health or sickness insurance delivered or issued for delivery in this State shall be entitled to the reimbursements and coverages specified below:
(1) Notwithstanding any provision to the contrary,
whenever a policy, contract, plan, or agreement provides for reimbursement for
any visual or optometric service[,] which is within the lawful scope of
practice of a duly licensed optometrist, the person entitled to benefits or the
person performing the services shall be entitled to reimbursement whether the
service is performed by a licensed physician or by a licensed optometrist.
Visual or optometric services shall include eye or visual examination [, or
both,] or a correction of any visual or muscular anomaly[,] and the
supplying of ophthalmic materials, lenses, contact lenses, spectacles,
eyeglasses, and appurtenances thereto;
(2) Notwithstanding any provision to the contrary,
for all policies, contracts, plans, or agreements issued on or after May 30,
1974, whenever provision is made for reimbursement or indemnity for any service
related to surgical or emergency procedures, which is within the lawful scope
of practice of any practitioner licensed to practice medicine in this State,
reimbursement or indemnification under [such] the policy,
contract, plan, or agreement shall not be denied when [such] the
services are performed by a dentist acting within the lawful scope of the
dentist's license;
(3) Notwithstanding any provision to the contrary,
whenever the policy provides reimbursement or payment for any service[,]
which is within the lawful scope of practice of a psychologist licensed in this
State, the person entitled to benefits or performing the service shall be
entitled to reimbursement or payment[,] whether the service is performed
by a licensed physician or licensed psychologist;
(4) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article 1 shall provide coverage for screening by low-dose mammography for occult breast cancer as follows:
(A) For women forty years of age and older, an annual mammogram; and
(B) For a woman of any age with a history of breast cancer or whose mother or sister has had a history of breast cancer, a mammogram upon the recommendation of the woman's physician.
The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements.
For the purpose of this paragraph, the term "low‑dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast. An insurer may provide the services required by this paragraph through contracts with providers; provided that the contract is determined to be a cost-effective means of delivering the services without sacrifice of quality and meets the approval of the director of health;
(5) (A) (i) Notwithstanding any provision to the
contrary, whenever a policy, contract, plan, or agreement provides coverage for
the children of the insured, that coverage shall also extend to the date of
birth of any newborn child to be adopted by the insured; provided that the
insured gives written notice to the insurer of the insured's intent to adopt
the child prior to the child's date of birth [or], within thirty
days after the child's birth, or within the time period required for
enrollment of a natural born child under the policy, contract, plan, or
agreement of the insured, whichever period is longer; provided further that if
the adoption proceedings are not successful, the insured shall reimburse the
insurer for any expenses paid for the child; and
(ii) Where notification has not been received by the insurer prior to the child's birth or within the specified period following the child's birth, insurance coverage shall be effective from the first day following the insurer's receipt of legal notification of the insured's ability to consent for treatment of the infant for whom coverage is sought; and
(B) When the insured is a member of a health
maintenance organization [(HMO)], coverage of an adopted newborn is
effective:
(i) From the date of birth of the adopted newborn when the newborn is treated from birth pursuant to a provider contract with the health maintenance organization, and written notice of enrollment in accord with the health maintenance organization's usual enrollment process is provided within thirty days of the date the insured notifies the health maintenance organization of the insured's intent to adopt the infant for whom coverage is sought; or
(ii) From the first day following receipt by the health maintenance organization of written notice of the insured's ability to consent for treatment of the infant for whom coverage is sought and enrollment of the adopted newborn in accord with the health maintenance organization's usual enrollment process if the newborn has been treated from birth by a provider not contracting or affiliated with the health maintenance organization; and
(6) Notwithstanding any provision to the contrary,
any policy, contract, plan, or agreement issued or renewed in this State shall
provide reimbursement for services within the respective allowable scope of
practice provided by advanced practice registered nurses recognized
pursuant to chapter 457[.] and naturopathic physicians licensed
pursuant to chapter 455. Services rendered by advanced practice registered
nurses and naturopathic physicians are subject to the same policy
limitations generally applicable to health care providers within the policy,
contract, plan, or agreement."
SECTION 6. Section 431:10A-120, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-120 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) Each policy of accident and health or sickness insurance, other than life insurance, disability income insurance, and long-term care insurance, issued or renewed in this State, each employer group health policy, contract, plan, or agreement issued or renewed in this State, all accident and health or sickness insurance policies issued or renewed in this State, all policies providing family coverages as defined in section 431:10A-103, and all policies providing reciprocal beneficiary family coverage as defined in section 431:10A-601, shall contain a provision for coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism for its policyholders or dependents of the policyholder in this State; provided that the medical food or low-protein modified food product is:
(1) Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and
(2) Consumed or administered enterally under the
supervision of a physician or osteopathic physician licensed under chapter 453[.]
or a naturopathic physician licensed under chapter 455.
Coverage shall be for at least eighty per cent of the cost of the medical food or low-protein modified food product prescribed and administered pursuant to this subsection.
(b) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to policyholders and shall be transmitted to policyholders during calendar year 2000 when annual information is made available to policyholders, or in any other mailing to policyholders, but in no case later than December 31, 2000.
(c) For the purposes of this section:
"Inborn error of metabolism" means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat.
"Low-protein modified food product" means a food product that:
(1) Is specially formulated to have less than one gram of protein per serving;
(2) Is prescribed or ordered by a physician or osteopathic physician, or a naturopathic physician as medically necessary for the dietary treatment of an inborn error of metabolism; and
(3) Does not include a food that is naturally low in protein.
"Medical food" means a food that is formulated to be consumed or administered enterally under the supervision of a physician or osteopathic physician, or a naturopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."
SECTION 7. Section 431:10A-206.5, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:
"(e) For the purposes of this section,
"child health supervision services" means [physician-delivered,
physician-supervised, or nurse-delivered services as defined by section 457-2
("registered nurse")] services supervised by a physician or
osteopathic physician licensed pursuant to chapter 453 or services delivered by
a physician or osteopathic physician licensed pursuant to chapter 453, a
naturopathic physician licensed pursuant to chapter 455, or a registered nurse
licensed pursuant to chapter 457 which shall include as the minimum benefit
coverage for services delivered at intervals and scope stated in this
section."
SECTION 8. Section 432:1-609, Hawaii Revised Statutes, is amended to read as follows:
"§432:1-609 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) All individual and group hospital and medical service plan contracts and medical service corporation contracts under this chapter shall provide coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism for its members or dependents of the member in this State; provided that the medical food or low-protein modified food product is:
(1) Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and
(2) Consumed or administered enterally under the
supervision of a physician or osteopathic physician licensed under chapter 453[.]
or a naturopathic physician licensed under chapter 455.
Coverage shall be for at least eighty per cent of the cost of the medical food or low-protein modified food product prescribed and administered pursuant to this subsection.
(b) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to members and shall be transmitted to members during calendar year 2000 when annual information is made available to members, or in any other mailing to members, but in no case later than December 31, 2000.
(c) For the purposes of this section:
"Inborn error of metabolism" means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat.
"Low-protein modified food product" means a food product that:
(1) Is specially formulated to have less than one gram of protein per serving;
(2) Is prescribed or ordered by a physician or osteopathic physician, or a naturopathic physician as medically necessary for the dietary treatment of an inherited metabolic disease; and
(3) Does not include a food that is naturally low in protein.
"Medical food" means a food that is formulated to be consumed or administered enterally under the supervision of a physician or osteopathic physician, or a naturopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."
SECTION 9. Section 432D-1, Hawaii Revised Statutes, is amended by amending the definition of "provider" to read as follows:
""Provider" means any physician, hospital, or other person, including a naturopathic physician practicing within the scope of licensure, licensed or otherwise authorized to furnish health care services."
SECTION 10. All health insurers subject to article 10A of chapter 431, Hawaii Revised Statutes, all mutual benefit societies and fraternal benefit societies subject to chapter 432, Hawaii Revised Statutes, and all health maintenance organizations subject to chapter 432D, Hawaii Revised Statutes, shall work collaboratively with the Board of Naturopathic Medicine to establish standards and criteria for certifying naturopathic physicians licensed pursuant to chapter 455 and practicing within the scope of licensure as participating providers under a contract to provide health care services to insureds or members no later than January 1, 2012, or the first open enrollment period after January 1, 2012. A health insurer, mutual benefit society, fraternal benefit society, or health maintenance organization shall retain the right to determine standards and criteria for certifying participating providers; provided that standards and criteria for certifying participating providers shall not categorically exclude naturopathic physicians practicing within the scope of licensure.
SECTION 11. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 12. This Act shall take effect upon its approval; provided that sections 4 through 9 of this Act shall take effect on January 1, 2012.
Report Title:
Naturopathic Physician; Insurance
Description:
Specifies requirements for coverage of services provided by naturopathic physicians by health insurers, mutual benefit societies, fraternal benefit societies, and health maintenance organizations; makes conforming amendments. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
