Bill Text: HI SB893 | 2024 | Regular Session | Introduced
Bill Title: Relating To Health Care.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-12-11 - Carried over to 2024 Regular Session. [SB893 Detail]
Download: Hawaii-2024-SB893-Introduced.html
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THE SENATE |
S.B. NO. |
893 |
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THIRTY-SECOND LEGISLATURE, 2023 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to health care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
SECTION 1. The legislature finds that Hawaii has long been a leader in advancing reproductive rights and advocating for access to affordable and comprehensive sexual and reproductive health care without discrimination. However, gaps in coverage and care still exist, and Hawaii benefits and protections have been threatened for years by a hostile federal administration that has attempted to restrict and repeal the federal Patient Protection and Affordable Care Act and limit access to sexual and reproductive health care. The Trump administration made it increasingly difficult for insurers to cover abortion care and assembled a Supreme Court that restricted abortion access and that may eliminate the Patient Protection and Affordable Care Act in the near future.
The legislature further finds that a
host of the Protection and Affordable Care Act provisions could soon be
eliminated, including coverage of preventive care with no patient cost‑sharing. These changes would force people in Hawaii to
pay more health care costs out-of-pocket, delay or forego care, and risk their
health and economic security. The
COVID-19 pandemic has cost thousands of people their jobs and health
insurance. Forcing Hawaii residents to
pay more for preventive care would create a new public health crisis in the
wake of a global pandemic.
The legislature further finds that access to sexual and reproductive health care is critical for the health and economic security of all people in Hawaii, particularly during a recession. Investing in no-cost preventive services will ultimately save Hawaii money because providing preventive care avoids the need for more expensive treatment and management in the future. No-cost preventive services would also support families in financial difficulty by helping people remain healthy and plan their families in a way that is appropriate for them. Ensuring that Hawaii's people receive comprehensive, client-centered, and culturally-competent sexual and reproductive health care is prudent economic policy that will improve the overall health of our State's communities.
In order to guarantee essential health benefits, safeguard access to abortion, limit out-of-pocket costs, and improve overall access to care, the legislature finds that it is vital to preserve certain aspects of the Patient Protection and Affordable Care Act and ensure access to health care for residents of Hawaii.
Accordingly, the purpose of this Act is to ensure comprehensive coverage for sexual and reproductive health care services, including family planning and abortion, for all people in Hawaii.
PART II
SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding two new sections to part I of article 10A to be appropriately designated and to read as follows:
"§431:10A-A Preventive care; coverage; requirements. (a)
Every individual policy of accident and health or sickness insurance
issued or renewed in this State shall provide coverage for all of the following
services, drugs, devices, products, and procedures for the policyholder or any
dependent of the policyholder who is covered by the policy:
(1) Well-woman
preventive care visit annually for women to obtain the recommended preventive
services that are age and developmentally appropriate, including preconception
care and services necessary for prenatal care.
For the purposes of this section and where appropriate, a "well-woman
visit" shall include other preventive services as listed in this section;
provided that if several visits are needed to obtain all necessary recommended
preventive services, depending upon a woman's health status, health needs, and
other risk factors, coverage shall apply to each of the necessary visits;
(2) Counseling for
sexually transmitted infections, including human immunodeficiency virus and
acquired immune deficiency syndrome;
(3) Screening
for: chlamydia; gonorrhea; hepatitis B;
hepatitis C; human immunodeficiency virus and acquired immune deficiency
syndrome; human papillomavirus; syphilis; anemia; urinary tract infection;
pregnancy; Rh incompatibility; gestational diabetes; osteoporosis; breast
cancer; and cervical cancer;
(4) Screening
to determine whether counseling and testing related to the BRCAl or BRCA2
genetic mutation is indicated and genetic counseling and testing related to the
BRCAl or BRCA2 genetic mutation, if indicated;
(5) Screening and
appropriate counseling or interventions for:
(A) Substance
abuse, including tobacco and electronic smoking devices, and alcohol; and
(B) Domestic
and interpersonal violence;
(6) Screening and
appropriate counseling or interventions for mental health screening and
counseling, including depression;
(7) Folic acid
supplements;
(8) Abortion;
(9) Breastfeeding
comprehensive support, counseling, and supplies;
(10) Breast cancer
chemoprevention counseling;
(11) Any
contraceptive supplies, as specified in section 431:l0A-116.6;
(12) Voluntary
sterilization, as a single claim or combined with the following other claims
for covered services provided on the same day:
(A) Patient
education and counseling on contraception and sterilization; and
(B) Services
related to sterilization or the administration and monitoring of contraceptive
supplies, including:
(i) Management
of side effects;
(ii) Counseling
for continued adherence to a prescribed regimen;
(iii) Device
insertion and removal; and
(iv) Provision
of alternative contraceptive supplies deemed medically appropriate in the
judgment of the insured's health care provider;
(13) Pre-exposure
prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination;
and
(14) Any additional
preventive services for women that must be covered without cost sharing under
title 42 United States Code section 300gg-13, as identified by the United
States Preventive Services Task Force or the Health Resources and Services
Administration of the United States Department of Health and Human Services, as
of January 1, 2019.
(b) An insurer shall not impose any cost-sharing
requirements, including copayments, coinsurance, or deductibles, on a
policyholder or an individual covered by the policy with respect to the
coverage and benefits required by this section, except to the extent that
coverage of particular services without cost-sharing would disqualify a
high-deductible health plan from eligibility for a health savings account
pursuant to title 26 United States Code section 223. For a qualifying high‑deductible health
plan, the insurer shall establish the plan's cost-sharing for the coverage
provided pursuant to this section at the minimum level necessary to preserve
the insured's ability to claim tax-exempt contributions and withdrawals from
the insured's health savings account under title 26 United States Code section
223.
(c) A health care provider shall be reimbursed
for providing the services pursuant to this section without any deduction for
coinsurance, copayments, or any other cost-sharing amounts.
(d) Except as otherwise authorized under this
section, an insurer shall not impose any restrictions or delays on the coverage
required under this section.
(e) This section shall not require a policy of
accident and health or sickness insurance to cover:
(1) Experimental or
investigational treatments;
(2) Clinical trials
or demonstration projects;
(3) Treatments that
do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for
which there is insufficient data to determine efficacy.
(f) If services, drugs, devices, products, or
procedures required by this section are provided by an out-of-network provider,
the insurer shall cover the services, drugs, devices, products, or procedures
without imposing any cost-sharing requirement on the policyholder if:
(1) There is no
in-network provider to furnish the service, drug, device, product, or procedure
that meets the requirements for network adequacy under section 431:26-103; or
(2) An in-network
provider is unable or unwilling to provide the service, drug, device, product,
or procedure in a timely manner.
(g) Every insurer shall provide written notice to
its policyholders regarding the coverage required by this section. The notice shall be in writing and
prominently positioned in any literature or correspondence sent to
policyholders and shall be transmitted to policyholders beginning with calendar
year 2024 when annual information is made available to policyholders or in any
other mailing to policyholders, but in no case later than December 31, 2024.
(h) This section shall not apply to policies that
provide coverage for specified diseases or other limited benefit health
insurance coverage, as provided pursuant to section 431:l0A-607.
(i) If the commissioner concludes that
enforcement of this section may adversely affect the allocation of federal
funds to the State, the commissioner may grant an exemption to the
requirements, but only to the minimum extent necessary to ensure the continued
receipt of federal funds.
(j) A bill or statement for services from any
health care provider or insurer shall be sent directly to the person receiving
the services.
(k) For purposes of this section,
"contraceptive supplies" shall have the same meaning as in section
431:l0A-116.6.
§431:l0A-B Nondiscrimination; reproductive health
care; coverage. (a) An individual, on the basis of actual or
perceived race, color, national origin, sex, gender identity, sexual
orientation, age, or disability, shall not be excluded from participation in,
be denied the benefits of, or otherwise be subjected to discrimination in the
coverage of, or payment for, the services, drugs, devices, products, and
procedures covered by section 431:l0A-A or 431:l0A-116.6.
(b) Violation of this section shall be considered
a violation pursuant to chapter 489.
(c) Nothing in this section shall be construed to limit any cause of action based upon any unfair or discriminatory practices for which a remedy is available under state or federal law."
SECTION 3. Chapter 431, Hawaii Revised Statutes, is amended by adding two new sections to part II of article 10A to be appropriately designated and to read as follows:
"§431:10A-C Preventive care; coverage; requirements. (a)
Every group policy of accident and health or sickness insurance issued
or renewed in this State shall provide coverage for all of the following
services, drugs, devices, products, and procedures for the policyholder or any
dependent of the insured who is covered by the policy:
(1) Well-woman
preventive care visit annually for women to obtain the recommended preventive
services that are age and developmentally appropriate, including preconception
care and services necessary for prenatal care.
For the purposes of this section and where appropriate, a "well-woman
visit" shall include other preventive services as listed in this section;
provided that if several visits are needed to obtain all necessary recommended
preventive services, depending upon a woman's health status, health needs, and
other risk factors, coverage shall apply to each of the necessary visits;
(2) Counseling for
sexually transmitted infections, including human immunodeficiency virus and
acquired immune deficiency syndrome;
(3) Screening
for: chlamydia; gonorrhea; hepatitis B;
hepatitis C; human immunodeficiency virus and acquired immune deficiency syndrome;
human papillomavirus; syphilis; anemia; urinary tract infection; pregnancy; Rh
incompatibility; gestational diabetes; osteoporosis; breast cancer; and
cervical cancer;
(4) Screening
to determine whether counseling and testing related to the BRCAl or BRCA2
genetic mutation is indicated and genetic counseling and testing related to the
BRCAl or BRCA2 genetic mutation, if indicated;
(5) Screening and
appropriate counseling or interventions for:
(A) Substance
abuse, including tobacco and electronic smoking devices, and alcohol; and
(B) Domestic
and interpersonal violence;
(6) Screening and
appropriate counseling or interventions for mental health screening and
counseling, including depression;
(7) Folic acid
supplements;
(8) Abortion;
(9) Breastfeeding
comprehensive support, counseling, and supplies;
(10) Breast cancer
chemoprevention counseling;
(11) Any
contraceptive supplies, as specified in section 431:l0A-116.6;
(12) Voluntary
sterilization, as a single claim or combined with the following other claims
for covered services provided on the same day:
(A) Patient
education and counseling on contraception and sterilization; and
(B) Services
related to sterilization or the administration and monitoring of contraceptive
supplies, including:
(i) Management
of side effects;
(ii) Counseling
for continued adherence to a prescribed regimen;
(iii) Device
insertion and removal; and
(iv) Provision
of alternative contraceptive supplies deemed medically appropriate in the
judgment of the insured's dependent's health care provider;
(13) Pre-exposure
prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination;
and
(14) Any additional
preventive services for women that must be covered without cost sharing under
title 42 United States Code section 300gg-13, as identified by the United
States Preventive Services Task Force or the Health Resources and Services
Administration of the United States Department of Health and Human Services, as
of January 1, 2019.
(b) An insurer shall not impose any cost-sharing
requirements, including copayments, coinsurance, or deductibles, on a
policyholder or an individual covered by the policy with respect to the
coverage and benefits required by this section, except to the extent that
coverage of particular services without cost-sharing would disqualify a
high-deductible health plan from eligibility for a health savings account
pursuant to title 26 United States Code section 223. For a qualifying high‑deductible health
plan, the insurer shall establish the plan's cost-sharing for the coverage
provided pursuant to this section at the minimum level necessary to preserve
the insured's ability to claim tax-exempt contributions and withdrawals from
the insured's health savings account under title 26 United States Code section
223.
(c) A health care provider shall be reimbursed
for providing the services pursuant to this section without any deduction for
coinsurance, copayments, or any other cost-sharing amounts.
(d) Except as otherwise authorized under this
section, an insurer shall not impose any restrictions or delays on the coverage
required under this section.
(e) This section shall not require a policy of
accident and health or sickness insurance to cover:
(1) Experimental or
investigational treatments;
(2) Clinical trials
or demonstration projects;
(3) Treatments that
do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for
which there is insufficient data to determine efficacy.
(f) If services, drugs, devices, products, or
procedures required by this section are provided by an out-of-network provider,
the insurer shall cover the services, drugs, devices, products, or procedures
without imposing any cost-sharing requirement on the insured if:
(1) There is no
in-network provider to furnish the service, drug, device, product, or procedure
that meets the requirements for network adequacy under section 431:26-103; or
(2) An in-network
provider is unable or unwilling to provide the service, drug, device, product,
or procedure in a timely manner.
(g) Every insurer shall provide written notice to
its subscribers regarding the coverage required by this section. The notice shall be in writing and
prominently positioned in any literature or correspondence sent to insured
members and shall be transmitted to insured members beginning with calendar
year 2024 when annual information is made available to subscribers or in any
other mailing to subscribers, but in no case later than December 31, 2024.
(h) This section shall not apply to policies that
provide coverage for specified diseases or other limited benefit health
insurance coverage, as provided pursuant to section 431:l0A-607.
(i) If the commissioner concludes that
enforcement of this section may adversely affect the allocation of federal
funds to the State, the commissioner may grant an exemption to the
requirements, but only to the minimum extent necessary to ensure the continued
receipt of federal funds.
(j) A bill or statement for services from any
health care provider or insurer shall be sent directly to the person receiving
the services.
(k) For purposes of this section,
"contraceptive supplies" shall have the same meaning as in section
431:l0A-116.6.
§431:l0A-D Nondiscrimination; reproductive health
care; coverage. (a) An individual, on the basis of actual or
perceived race, color, national origin, sex, gender identity, sexual orientation,
age, or disability, shall not be excluded from participation in, be denied the
benefits of, or otherwise be subjected to discrimination in the coverage of, or
payment for, the services, drugs, devices, products, and procedures covered by
section 431:l0A-C or 431:l0A-116.6.
(b) Violation of this section shall be considered
a violation pursuant to chapter 489.
(c) Nothing in this section shall be construed to limit any cause of action based upon any unfair or discriminatory practices for which a remedy is available under state or federal law."
SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding two new sections to article 1 to be appropriately designated and to read as follows:
"§432:1-A Preventive care; coverage; requirements. (a)
Every individual or group hospital or medical service plan contract issued
or renewed in this State shall provide coverage for all of the following
services, drugs, devices, products, and procedures for the subscriber or member
or any dependent of the subscriber or member who is covered by the plan
contract:
(1) Well-woman
preventive care visit annually for women to obtain the recommended preventive
services that are age and developmentally appropriate, including preconception
care and services necessary for prenatal care.
For the purposes of this section and where appropriate, a "well-woman
visit" shall include other preventive services as listed in this section;
provided that if several visits are needed to obtain all necessary recommended
preventive services, depending upon a woman's health status, health needs, and
other risk factors, coverage shall apply to each of the necessary visits;
(2) Counseling for
sexually transmitted infections, including human immunodeficiency virus and
acquired immune deficiency syndrome;
(3) Screening
for: chlamydia; gonorrhea; hepatitis B;
hepatitis C; human immunodeficiency virus and acquired immune deficiency
syndrome; human papillomavirus; syphilis; anemia; urinary tract infection;
pregnancy; Rh incompatibility; gestational diabetes; osteoporosis; breast
cancer; and cervical cancer;
(4) Screening
to determine whether counseling and testing related to the BRCAl or BRCA2
genetic mutation is indicated and genetic counseling and testing related to the
BRCAl or BRCA2 genetic mutation, if indicated;
(5) Screening and
appropriate counseling or interventions for:
(A) Substance
abuse, including tobacco and electronic smoking devices, and alcohol; and
(B) Domestic
and interpersonal violence;
(6) Screening and
appropriate counseling or interventions for mental health screening and
counseling, including depression;
(7) Folic acid
supplements;
(8) Abortion;
(9) Breastfeeding
comprehensive support, counseling, and supplies;
(10) Breast cancer
chemoprevention counseling;
(11) Any
contraceptive supplies, as specified in section 431:l0A-116.6;
(12) Voluntary
sterilization, as a single claim or combined with the following other claims
for covered services provided on the same day:
(A) Patient
education and counseling on contraception and sterilization; and
(B) Services
related to sterilization or the administration and monitoring of contraceptive
supplies, including:
(i) Management
of side effects;
(ii) Counseling
for continued adherence to a prescribed regimen;
(iii) Device
insertion and removal; and
(iv) Provision
of alternative contraceptive supplies deemed medically appropriate in the
judgment of the subscriber's or member's health care provider;
(13) Pre-exposure
prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination;
and
(14) Any additional
preventive services for women that must be covered without cost sharing under
title 42 United States Code section 300gg-13, as identified by the United
States Preventive Services Task Force or the Health Resources and Services
Administration of the United States Department of Health and Human Services, as
of January 1, 2019.
(b) A mutual benefit society shall not impose any
cost‑sharing requirements, including copayments, coinsurance, or
deductibles, on a subscriber or member or an individual covered by the plan
contract with respect to the coverage and benefits required by this section,
except to the extent that coverage of particular services without cost-sharing
would disqualify a high-deductible health plan from eligibility for a health
savings account pursuant to title 26 United States Code section 223. For a qualifying high-deductible health plan,
the mutual benefit society shall establish the plan's cost-sharing for the
coverage provided pursuant to this section at the minimum level necessary to
preserve the subscriber's or member's ability to claim tax-exempt contributions
and withdrawals from the subscriber's or member's health savings account under
title 26 United States Code section 223.
(c) A health care provider shall be reimbursed
for providing the services pursuant to this section without any deduction for
coinsurance, copayments, or any other cost-sharing amounts.
(d) Except as otherwise authorized under this
section, a mutual benefit society shall not impose any restrictions or delays
on the coverage required under this section.
(e) This section shall not require an individual
or group hospital or medical service plan contract to cover:
(1) Experimental or
investigational treatments;
(2) Clinical trials
or demonstration projects;
(3) Treatments that
do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which
there is insufficient data to determine efficacy.
(f) If services, drugs, devices, products, or
procedures required by this section are provided by an out-of-network provider,
the mutual benefit society shall cover the services, drugs, devices, products,
or procedures without imposing any cost-sharing requirement on the subscriber
or member if:
(1) There is no
in-network provider to furnish the service, drug, device, product, or procedure
that meets the requirements for network adequacy under section 431:26-103; or
(2) An in-network
provider is unable or unwilling to provide the service, drug, device, product,
or procedure in a timely manner.
(g) Every mutual benefit society shall provide
written notice to its subscribers or members regarding the coverage required by
this section. The notice shall be in
writing and prominently positioned in any literature or correspondence sent to subscribers
or members and shall be transmitted to subscribers or members beginning with
calendar year 2024 when annual information is made available to subscribers or
members or in any other mailing to subscribers or members, but in no case later
than December 31, 2024.
(h) This section shall not apply to plan
contracts that provide coverage for specified diseases or other limited benefit
health insurance coverage, as provided pursuant to section 431:l0A-607.
(i) If the commissioner concludes that
enforcement of this section may adversely affect the allocation of federal
funds to the State, the commissioner may grant an exemption to the
requirements, but only to the minimum extent necessary to ensure the continued
receipt of federal funds.
(j) A bill or statement for services from any
health care provider or mutual benefit society shall be sent directly to the
person receiving the services.
(k) For purposes of this section,
"contraceptive supplies" shall have the same meaning as in section
431:l0A-116.6.
§432:l-B Nondiscrimination; reproductive health
care; coverage. (a) An individual, on the basis of actual or
perceived race, color, national origin, sex, gender identity, sexual
orientation, age, or disability, shall not be excluded from participation in,
be denied the benefits of, or otherwise be subjected to discrimination in the
coverage of, or payment for, the services, drugs, devices, products, and
procedures covered by section 432:1-A or 432:1-604.5.
(b) Violation of this section shall be considered
a violation pursuant to chapter 489.
(c) Nothing in this section shall be construed to limit any cause of action based upon any unfair or discriminatory practices for which a remedy is available under state or federal law."
SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432D-A Nondiscrimination; reproductive health
care; coverage. (a) An individual, on the basis of actual or
perceived race, color, national origin, sex, gender identity, sexual
orientation, age, or disability, shall not be excluded from participation in,
be denied the benefits of, or otherwise be subjected to discrimination in the
coverage of, or payment for, the services, drugs, devices, products, and
procedures covered by section 431:10-A or 431:10A-116.6.
(b) Violation of this section shall be considered
a violation pursuant to chapter 489.
(c) Nothing in this section shall be construed to limit any cause of action based upon any unfair or discriminatory practices for which a remedy is available under state or federal law."
SECTION 6. Section 431:10A-116.6, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-116.6 Contraceptive
services. (a) Notwithstanding any provision of law to the
contrary, each employer group policy of accident and health or sickness [policy,
contract, plan, or agreement] insurance issued or renewed in this
State on or after January 1, [2000,] 2024,
shall [cease to exclude] provide coverage for contraceptive
services or contraceptive supplies for the [subscriber] insured
or any dependent of the [subscriber] insured who is covered by
the policy, subject to the exclusion under section 431:10A-116.7 and the
exclusion under section 431:10A-607[.
(b) Except as provided in subsection (c), all
policies, contracts, plans, or agreements under subsection (a) that provide
contraceptive services or supplies or prescription drug coverage shall not
exclude any prescription contraceptive supplies or impose any unusual
copayment, charge, or waiting requirement for such supplies.
(c) Coverage for oral contraceptives shall
include at least one brand from the monophasic, multiphasic, and the
progestin-only categories. A member
shall receive coverage for any other oral contraceptive only if:
(1) Use of brands
covered has resulted in an adverse drug reaction; or
(2) The member has
not used the brands covered and, based on the member's past medical history,
the prescribing health care provider believes that use of the brands covered
would result in an adverse reaction.
(d)]; provided that:
(1) If there is a therapeutic equivalent
of a contraceptive supply approved by the United States Food and Drug
Administration, an insurer may provide coverage for either the requested
contraceptive supply or for one or more therapeutic equivalents of the
requested contraceptive supply;
(2) If a contraceptive supply covered by
the policy is deemed medically inadvisable by the insured's health care
provider, the policy shall cover an alternative contraceptive supply prescribed
by the health care provider;
(3) An insurer shall pay pharmacy claims
for reimbursement of all contraceptive supplies available for over‑the‑counter
sale that are approved by the United States Food and Drug Administration; and
(4) An insurer may not infringe upon an
insured's choice of contraceptive supplies and may not require prior
authorization, step therapy, or other utilization control techniques for
medically-appropriate covered contraceptive supplies.
(b)
An insurer shall not impose any cost-sharing requirements,
including copayments, coinsurance, or deductibles, on an insured with respect
to the coverage required under this section.
A health care provider shall be reimbursed for providing the services
pursuant to this section without any deduction for coinsurance, copayments, or
any other cost-sharing amounts.
(c) Except as otherwise provided by this section,
an insurer shall not impose any restrictions or delays on the coverage required
by this section.
(d) Coverage required by this section shall not
exclude coverage for contraceptive supplies prescribed by a health care
provider, acting within the provider's scope of practice, for:
(1) Reasons other
than contraceptive purposes, such as decreasing the risk of ovarian cancer or
eliminating symptoms of menopause; or
(2) Contraception
that is necessary to preserve the life or health of an insured.
(e) Coverage required by this section shall include reimbursement to a prescribing health care provider or dispensing entity for prescription contraceptive supplies intended to last for up to a twelve-month period for an insured.
[(e)] (f) Coverage required by this section shall
include reimbursement to a prescribing and dispensing pharmacist who prescribes
and dispenses contraceptive supplies pursuant to section 461-11.6.
(g) Nothing in this section shall be construed to
extend the practices or privileges of any health care provider beyond that
provided in the laws governing the provider's practice and privileges.
(h) For purposes of this section:
"Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy.
"Contraceptive supplies"
means all United States Food and Drug Administration-approved contraceptive drugs
[or], devices, or products used to prevent unwanted
pregnancy[.], regardless of whether they are to be used by the
insured or the partner of the insured, and regardless of whether they are to be
used for contraception or exclusively for the prevention of sexually
transmitted infections.
[(f) Nothing in this section shall be construed to
extend the practice or privileges of any health care provider beyond that
provided in the laws governing the provider's practice and privileges.]"
SECTION 7. Section 431:10A-116.7, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:
"(g) For purposes of this section:
"Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy.
"Contraceptive supplies"
means all United States Food and Drug Administration-approved contraceptive drugs
[or], devices, or products used to prevent unwanted
pregnancy[.], regardless of whether they are to be used by the
insured or the partner of the insured, and regardless of whether they are to be
used for contraception or exclusively for the prevention of sexually
transmitted infections."
SECTION 8. Section 432:1-604.5, Hawaii Revised Statutes, is amended to read as follows:
"§432:1-604.5 Contraceptive
services. (a) Notwithstanding any provision of law to the
contrary, each employer group [health policy, contract, plan, or agreement]
hospital or medical service plan contract issued or renewed in this
State on or after January 1, [2000,] 2024, shall [cease to
exclude] provide coverage for contraceptive services or contraceptive
supplies, and contraceptive prescription drug coverage for the subscriber or
member, or any dependent of the subscriber or member who is covered
by the policy, subject to the exclusion under section 431:10A-116.7[.
(b) Except as provided in subsection (c), all
policies, contracts,
plans, or agreements under subsection (a), that provide contraceptive services
or supplies or prescription drug coverage shall not exclude any prescription
contraceptive supplies or impose any unusual copayment, charge, or waiting
requirement for such drug or device.
(c) Coverage for contraceptives shall include at
least one brand
from the monophasic, multiphasic, and the progestin-only categories. A member shall receive coverage for any other
oral contraceptive only if:
(1) Use of brands
covered has resulted in an adverse drug reaction; or
(2) The member has
not used the brands covered and, based on the member's past medical history,
the prescribing health care provider believes that use of the brands covered
would result in an adverse reaction.
(d)]; provided that:
(1) If there is a
therapeutic equivalent of a contraceptive supply approved by the United States Food
and Drug Administration, a mutual benefit society may provide coverage for
either the requested contraceptive supply or for one or more therapeutic
equivalents of the requested contraceptive supply;
(2) If a
contraceptive supply covered by the plan contract is deemed medically
inadvisable by the subscriber's or member's health care provider, the plan
contract shall cover an alternative contraceptive supply prescribed by the
health care provider;
(3) A mutual
benefit society shall pay pharmacy claims for reimbursement of all
contraceptive supplies available for over-the-counter sale that are approved by
the United States Food and Drug Administration; and
(4) A mutual
benefit society shall not infringe upon a subscriber's or member's choice of
contraceptive supplies and shall not require prior authorization, step therapy,
or other utilization control techniques for medically-appropriate covered
contraceptive supplies.
(b) A mutual benefit society shall not impose any
cost‑sharing requirements, including copayments, coinsurance, or
deductibles, on a subscriber or member with respect to the coverage required
under this section. A health care
provider shall be reimbursed for providing the services pursuant to this
section without any deduction for coinsurance, copayments, or any other cost-sharing
amounts.
(c) Except as otherwise provided by this section,
a mutual benefit society shall not impose any restrictions or delays on the
coverage required by this section.
(d) Coverage required by this section shall not
exclude coverage for contraceptive supplies prescribed by a health care
provider, acting within the provider's scope of practice, for:
(1) Reasons other
than contraceptive purposes, such as decreasing the risk of ovarian cancer or
eliminating symptoms of menopause; or
(2) Contraception
that is necessary to preserve the life or health of a subscriber or member.
(e) Coverage required by this section shall include reimbursement to a prescribing health care provider or dispensing entity for prescription contraceptive supplies intended to last for up to a twelve-month period for a member.
[(e)] (f) Coverage
required by this section shall include reimbursement to a prescribing and
dispensing pharmacist who prescribes and dispenses contraceptive supplies
pursuant to section 461-11.6.
(g) Nothing in this section shall be construed to
extend the practice or privileges of any health care provider beyond that
provided in the laws governing the provider's practice and privileges.
(h) For purposes of this section:
"Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy.
"Contraceptive supplies"
means all Food and Drug Administration-approved
contraceptive drugs or devices used to prevent unwanted pregnancy[.
(f) Nothing in this section shall be construed to
extend the practice or privileges of any health care provider beyond that provided in the
laws governing the provider's practice and privileges.], regardless of
whether they are to be used by the subscriber or member or the partner of the
subscriber or member, and regardless of whether they are to be used for
contraception or exclusively for the prevention of sexually transmitted
infections."
SECTION 9. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
"§432D-23 Required provisions and
benefits. Notwithstanding any
provision of law to the contrary, each policy, contract, plan, or agreement
issued in the State after January 1, 1995, by health maintenance organizations
pursuant to this chapter, shall include benefits provided in sections
431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A‑116.2,
431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121,
431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134,
431:10A-140, and [431:10A-134,] 431:10A-A, and chapter
431M."
PART III
SECTION 10. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346-A Nondiscrimination; reproductive health
care; coverage. (a) An individual, on the basis of actual or
perceived race, color, national origin, sex, gender identity, sexual
orientation, age, or disability, shall not be excluded from participation in,
be denied the benefits of, or otherwise be subjected to discrimination in the
coverage of, or payment for, the services, drugs, devices, products, or
procedures covered by section 432:1-A or 432:1-604.5 or in the receipt of
medical assistance as that term is defined under section 346-1.
(b) Violation of this section shall be considered
a violation pursuant to chapter 489.
(c) Nothing in this section shall be construed to
limit any cause of action based upon any unfair or discriminatory practices for
which a remedy is available under state or federal law."
PART IV
SECTION 11. No later than twenty days prior the convening of the regular session of 2025, the insurance division of the department of commerce and consumer affairs shall submit a report to the legislature on the degree of compliance by insurers, mutual benefit societies, and health maintenance organizations regarding the implementation of this Act, and of any actions taken by the insurance commissioner to enforce compliance with this Act.
SECTION 12. In codifying the new sections added by sections 2, 3, 4, 5, and 10 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.
SECTION 13. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 14. This Act shall take effect on January 1, 2024, and shall apply to all plans, policies, contracts, and agreements of health insurance issued or renewed by a health insurer, mutual benefit society, or health maintenance organization on or after January 1, 2024.
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Report Title:
Health Care; Insurance
Description:
Requires health insurance coverage for various sexual and reproductive health care services.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
