SECTION 1. The legislature finds that section 2706 of the federal Public Health Service Act (section 2706), as added by section 1201 of the federal Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), prohibits a group health plan and a health insurance insurer offering group or individual health insurance coverage from discriminating with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law.

The legislature further finds that section 2706 has been understood to prohibit plans from covering a given service when offered by one type of licensed provider while denying coverage when the same service is provided by another type of licensed provider. The legislature additionally finds that discrimination against any provider group, as a whole, is harmful to patients and restricts their ability to select the provider of their choice.

The legislature also finds that health plans and insurance companies in the State have limited the types of health care providers permitted to provide services to their members by excluding certain non-medical doctor licensed providers. In particular, naturopathic physicians are often excluded from insurance contracts in Hawaii, which forces patients who choose a naturopathic physician as their primary care provider to pay out of pocket for their primary care needs.

The legislature concludes that the ability for patients to choose the licensed provider of their choice is integral to the intended full implementation of the Affordable Care Act and is an embodiment of the federal government's goals of better access, increased cost efficiency, and enhanced quality of health care.

Accordingly, the purpose of this Act is to provide clarity that naturopathic physicians must be compensated appropriately, similar to other licensed providers and without discrimination, per the requirements of section 2706 of the Affordable Care Act.

SECTION 2. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§431:10A- Naturopathic physicians; non-discrimination; coverage. (a) An individual and group accident and health or sickness policy, contract, plan, or agreement that provides health care coverage shall provide coverage for medically necessary health care services covered by the policy, contract, plan, or agreement when provided by a naturopathic physician licensed under chapter 455 for treatment within the naturopathic physician's scope of practice.

(b) Health care services provided by naturopathic physicians may be subject to reasonable deductibles, copayment and coinsurance amounts, fee or benefit limits, practice parameters, cost-effectiveness and clinical efficacy standards, and utilization review consistent with any applicable law or rules.

(c) Any amounts, limits, standards, and review shall not function to direct treatment in a manner that unfairly discriminates against the practice of naturopathic medicine. These amounts, limits, standards, and review shall be no more restrictive than those applicable under the same policy, contract, plan, or agreement to care or services provided by other primary care providers; provided that any amounts, limits, standards, and review may allow for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers.

(d) An individual and group accident and health or sickness policy, contract, plan, or agreement may require that a naturopathic physician's services be provided by a licensed naturopathic physician under contract with an insurer or shall be covered in a manner consistent with out-of-network provider reimbursement practices for primary care providers.

(e) This section shall not be construed to impede or prevent the provision or coverage of health care services by licensed naturopathic physicians acting within their authorized scope of practice."

SECTION 3. Chapter 432:1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432:1- Naturopathic physicians; non-discrimination; coverage. (a) An individual and group hospital or medical service plan, policy, contract, or agreement that provides coverage shall provide coverage for medically necessary health care services covered by the plan, policy, contract, or agreement when provided by a naturopathic physician licensed under chapter 455 for treatment within the naturopathic physician's scope of practice.

(c) Any amounts, limits, standards, and review shall not function to direct treatment in a manner that unfairly discriminates against the practice of naturopathic medicine. These amounts, limits, standards, and review shall be no more restrictive than those applicable under the same plan, policy, contract, or agreement to care or services provided by other primary care providers; provided that any amounts, limits, standards, and review may allow for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers.

(d) An individual and group hospital or medical service plan, policy, contract, or agreement may require that a naturopathic physician's services be provided by a licensed naturopathic physician under contract with a mutual benefit society or shall be covered in a manner consistent with out-of-network provider reimbursement practices for primary care providers.

(e) This section shall not be construed to impede or prevent the provision or coverage of health care services by licensed naturopathic physicians acting within their authorized scope of practice."

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432D- Naturopathic physicians; non-discrimination; coverage. (a) A health maintenance organization that provides coverage under an individual contract or group contract shall provide coverage for medically necessary health care services covered by the individual contract or group contract when provided by a naturopathic physician licensed under chapter 455 for treatment within the naturopathic physician's scope of practice.

(c) Any amounts, limits, standards, and review shall not function to direct treatment in a manner that unfairly discriminates against the practice of naturopathic medicine. These amounts, limits, standards, and review shall be no more restrictive than those applicable under the same plan, policy, contract, or agreement to care or services provided by other primary care providers; provided that any amounts, limits, standards, and review may allow for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers.

(d) A health maintenance organization may require that a naturopathic physician's services be provided by a licensed naturopathic physician under contract with a health maintenance organization or shall be covered in a manner consistent with out-of-network provider reimbursement practices for primary care providers.

(e) This section shall not be construed to impede or prevent the provision or coverage of health care services by licensed naturopathic physicians acting within their authorized scope of practice."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 2050.

THE SENATE	S.B. NO.	1217
TWENTY-EIGHTH LEGISLATURE, 2015		S.D. 1
STATE OF HAWAII