(a) Alcohol and drug dependence benefits shall be as follows:

Terms Used In Hawaii Revised Statutes 431M-4

  • Advanced practice registered nurse: means a person licensed pursuant to chapter 457. See Hawaii Revised Statutes 431M-1
  • Alcohol or drug dependence outpatient services: means alcohol or drug dependence nonresidential treatment provided on an ambulatory basis to patients with alcohol or drug dependence problems that includes interventions prescribed and performed by qualified physicians, psychologists, licensed clinical social workers, licensed marriage and family therapists, licensed mental health [counselors], or advanced practice registered nurses. See Hawaii Revised Statutes 431M-1
  • Certified substance abuse counselor: means a person who is certified pursuant to § 321-193. See Hawaii Revised Statutes 431M-1
  • Detoxification services: means the process whereby a person intoxicated by alcohol, drugs, or both, or a person who is dependent upon alcohol, drugs, or both, is assisted through the period of time necessary to eliminate, by metabolic or other means, the intoxicating alcohol or drug dependency factors, as determined by a physician or advanced practice registered nurse, while keeping the physiological risk to the person at a minimum. See Hawaii Revised Statutes 431M-1
  • Drug dependence: means any pattern of pathological use of drugs causing impairment in social or occupational functioning and producing psychological or physiological dependency or both, evidenced by physical tolerance or withdrawal. See Hawaii Revised Statutes 431M-1
  • Hospital: means a facility licensed as a hospital by the department of health and accredited by The Joint Commission. See Hawaii Revised Statutes 431M-1
  • In-hospital services: means the provision of medical, nursing, or therapeutic services twenty-four hours a day in a hospital. See Hawaii Revised Statutes 431M-1
  • Licensed clinical social worker: means a person who is a licensed clinical social worker pursuant to chapter 467E. See Hawaii Revised Statutes 431M-1
  • Licensed dietitian: means a person who uses the title of licensed dietitian or dietitian and has been licensed to practice dietetics under chapter 448B. See Hawaii Revised Statutes 431M-1
  • Licensed marriage and family therapist: means a person licensed in marriage and family therapy practice pursuant to chapter 451J. See Hawaii Revised Statutes 431M-1
  • Licensed mental health counselor: means a person:

    (1) Who engages in the practice of [mental] health counseling and uses the title of licensed mental health counselor;

    (2) Who is licensed in mental health counseling practice pursuant to chapter 453D; and

    (3) Whose license is in effect and not revoked or suspended. See Hawaii Revised Statutes 431M-1

  • Mental health outpatient facility: means a mental health establishment, clinic, institution, center, or community mental health center that provides for the diagnosis, treatment, care, or rehabilitation of mentally ill persons and has been accredited by The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health. See Hawaii Revised Statutes 431M-1
  • Mental health outpatient services: means mental health nonresidential treatment provided on an ambulatory basis to patients with mental illness that includes interventions prescribed and performed by a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse. See Hawaii Revised Statutes 431M-1
  • Mental illness: means a syndrome of clinically significant psychological, biological, or behavioral abnormalities that results in personal distress or suffering, impairment of capacity for functioning, or both. See Hawaii Revised Statutes 431M-1
  • Nonhospital facility: means a facility for the care or treatment of alcohol dependent, drug dependent, or mentally ill persons that has been accredited by The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health and, if residential, has been licensed as a special treatment facility by the department of health. See Hawaii Revised Statutes 431M-1
  • Partial hospitalization: means treatment services, including in-hospital treatment services or benefits, provided by a hospital or mental health outpatient facility to patients who, because of their conditions, require more than periodic hourly service. See Hawaii Revised Statutes 431M-1
  • Physician: means a person licensed in the practice of medicine or osteopathy pursuant to chapter 453. See Hawaii Revised Statutes 431M-1
  • Psychologist: means a person licensed in the practice of psychology pursuant to chapter 465. See Hawaii Revised Statutes 431M-1
  • Qualified: means :

    (1) Having skill in the diagnosis or treatment of substance use disorders, based on a practitioner's credentials, including but not limited to professional education, clinical training, licensure, board or other certification, clinical experience, letters of reference, other professional qualifications, and disciplinary action; or

    (2) Being a licensed physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse, and certified pursuant to chapter 321. See Hawaii Revised Statutes 431M-1

  • Substance abuse services: means the provision of medical, psychological, nursing, counseling, or therapeutic services in response to a treatment plan for alcohol or drug dependence or both which shall include, when appropriate, a combination of aftercare and individual, group, and family counseling services provided by qualified staff. See Hawaii Revised Statutes 431M-1
(1) Detoxification services as a covered benefit under this chapter shall be provided either in a hospital or in a nonhospital facility that has a written affiliation agreement with a hospital for emergency, medical, and mental health support services. The following services shall be covered under detoxification services:

(A) Room and board;
(B) Diagnostic x-rays;
(C) Laboratory testing; and
(D) Drugs, equipment use, special therapies, and supplies.

Detoxification services shall be included as part of the covered in-hospital services;

(2) Alcohol or drug dependence treatment through in-hospital, nonhospital residential, or day treatment substance abuse services as a covered benefit under this chapter shall be provided in a hospital or nonhospital facility. Before a person qualifies to receive benefits under this subsection, a qualified physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse shall determine that the person suffers from alcohol or drug dependence, or both; provided that the substance abuse services covered under this paragraph shall include those services that are required for licensure and accreditation. Excluded from alcohol or drug dependence treatment under this subsection are detoxification services and educational programs to which drinking or drugged drivers are referred by the judicial system and services performed by mutual self-help groups;
(3) Alcohol or drug dependence outpatient services as a covered benefit under this chapter shall be provided under an individualized treatment plan approved by a qualified physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse and shall be services reasonably expected to produce remission of the patient’s condition. An individualized treatment plan approved by a licensed marriage and family therapist, licensed mental health counselor, licensed clinical social worker, or an advanced practice registered nurse for a patient already under the care or treatment of a physician or psychologist shall be done in consultation with the physician or psychologist; and
(4) Substance abuse assessments for alcohol or drug dependence as a covered benefit under this section for a child facing disciplinary action under section 302A-1134.6 shall be provided by a qualified physician, psychologist, licensed clinical social worker, advanced practice registered nurse, or certified substance abuse counselor. The certified substance abuse counselor shall be employed by a hospital or nonhospital facility providing substance abuse services. The substance abuse assessment shall evaluate the suitability for substance abuse treatment and placement in an appropriate treatment setting.
(b) Mental illness benefits.

(1) Covered benefits for mental health services set forth in this subsection shall be limited to coverage for diagnosis and treatment of mental disorders. All mental health services shall be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, licensed 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. An individualized treatment plan approved by a licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, advanced practice registered nurse, or a licensed dietitian treating eating disorders, for a patient already under the care or treatment of a physician or psychologist shall be done in consultation with the physician or psychologist;
(2) In-hospital and nonhospital residential mental health services as a covered benefit under this chapter shall be provided in a hospital or a nonhospital residential facility. The services to be covered shall include those services required for licensure and accreditation;
(3) Mental health partial hospitalization as a covered benefit under this chapter shall be provided by a hospital or a mental health outpatient facility. The services to be covered under this paragraph shall include those services required for licensure and accreditation; and
(4) Mental health outpatient services shall be a covered benefit under this chapter.