Hawaii Legislation

SB 889 establishes a Mental Health and Substance Abuse Parity Working Group and outlines the duties and expectations of said group. Additionally, the bill amends Hawaii Revised Statutes Chaper 431M to reauthorize parity requirements for all individual and group accident and health or sickness insurance policies.

• Extent the service is utilized, available, and the level of public demand for both service and coverage
• Extent to which lack of coverage leads to inability to obtain care
• Extent to which the care poses a financial hardship on the consumer when the coverage is not available
• Impact of providing coverage (such as morbidity, mortality, quality of care, etc.) and impact of indirect costs and benefits of coverage

The report of financial impact of such coverage will include:

• Extent coverage increased or decreased cost of treatment
• Extend coverage may increase use of treatment or as an alternative for more expensive treatment
• Extent insurer could be reasonable expected to raise premiums and administrative expenses
• Impact on the total cost of healthcare

This bill amends state law by requiring insurers to cover clinical victim support services by qualified mental health providers for victims of sexual violence and abuse who are diagnosed with mental disorders.

• Cover autism services through age 20
• Cover $50,000 annual maximum and $300,000 lifetime maximum (these can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cannot require a child who has been diagnosed according to criteria from a previous edition of the DSM to be reevaluated according to diagnostic criteria from the current edition of the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)

• Cover autism services through age 20
• Cover $50,000 annual maximum and $300,000 lifetime maximum (these can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cannot require a child who has been diagnosed according to criteria from a previous edition of the DSM to be reevaluated according to diagnostic criteria from the current edition of the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)
• Have at least as many board-certified behavior analysts who have in-network status as psychologists with in-network status

• Cover autism services through age 20
• Cover $50,000 annual maximum and $300,000 lifetime maximum (these can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cannot require a child who has been diagnosed according to criteria from a previous edition of the DSM to be reevaluated according to diagnostic criteria from the current edition of the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)
• Have at least as many board-certified behavior analysts who have in-network status as psychologists with in-network status

• Cover autism services through age 5
• Financial requirements for autism services must be the same as those used for other medical services
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cannot require a child who has been diagnosed according to criteria from a previous edition of the DSM to be reevaluated according to diagnostic criteria from the current edition of the DSM
• Cover behavioral health treatment (applied behavior analysis )

• Cover autism services through age 25
• Cover $50,000 annual maximum (can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cannot require a child who has been diagnosed according to criteria from a previous edition of the DSM to be reevaluated according to diagnostic criteria from the current edition of the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)
• Have at least as many board-certified behavior analysts who have in-network status as psychologists with in-network status

• Cover autism services through age 20
• Cover $50,000 annual maximum and $300,000 lifetime maximum (these can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cannot require a child who has been diagnosed according to criteria from a previous edition of the DSM to be reevaluated according to diagnostic criteria from the current edition of the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)
• Have at least as many board-certified behavior analysts who have in-network status as psychologists with in-network status

• Coverage options, including mandatory coverage of mental illnesses and substance use disorders
• Definitions of covered conditions and other terms necessary to implement the State’s parity laws
• Individual plans and small employer fully-insured plans
• Annual maximums, lifetime maximums, annual limits, and lifetime limits
• Determinations of medical necessity
• Managed care
• Out-of-network coverage
• Adequacy of network provider panels
• Prescription medications
• Specific services for serious mental illness
• Oversight of implementation
• Independent external review of claims

• Cover autism (no age specified)
• Cover $50,000 annual maximum (can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Can only review a child’s treatment plan once a year
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)
• Have at least as many board-certified behavior analysts who have in-network status as psychologists with in-network status

• Psychiatric care
• Psychological care
• Therapeutic care
• Pharmacy care
• Rehabilitative care
• Any treatment determined medically necessary by the Hawaii Department of Health

• Psychiatric care
• Psychological care
• Therapeutic care
• Pharmacy care
• Rehabilitative care
• Any treatment determined medically necessary by the Hawaii Department of Health

• Coverage options, including mandatory coverage of mental illnesses and substance use disorders
• Definitions of covered conditions and other terms necessary to implement the State’s parity laws
• Individual plans and small employer fully-insured plans
• Annual maximums, lifetime maximums, annual limits, and lifetime limits
• Determinations of medical necessity
• Managed care
• Out-of-network coverage
• Adequacy of network provider panels
• Prescription medications
• Specific services for serious mental illness
• Oversight of implementation
• Independent external review of claims

Among other things, this bill tried to change an old section of the state insurance law related to parity so that it would apply to major depressive disorder, anxiety disorder, and borderline personality disorder. This section has since been repealed from the state insurance law (the current parity sections of the state insurance law are summarized at the bottom of this page under “Hawaii Parity Law”).

• Cover autism through age 25
• Cover $50,000 annual maximum (can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Can only review a child’s treatment plan once a year
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)

• Cover autism (no age specified)
• Cover $50,000 annual maximum (can be adjusted for inflation)
• Cannot limit outpatient visits
• Financial requirements for autism services must be the same as those used for other medical services
• Can only review a child’s treatment plan once a year
• Define autism spectrum disorder as any pervasive developmental disorder or autistic disorder in the DSM
• Cover behavioral health treatment (applied behavior analysis ), pharmacy care, psychiatric care, psychological care, and therapeutic care (all of these are defined in the bill)

• No language about plans complying with the Federal Parity Law
• No language about quantitative treatment limitations and non-quantitative treatment limitations