Hawaii-2014-SCR35-Amended

WHEREAS, infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children; and

WHEREAS, in the United States, infertility affects about 7.3 million women and their partners, approximately twelve percent of the reproductive age population, or one in eight couples; and

WHEREAS, most infertility cases – eighty-five to ninety percent - are treated with conventional medical therapies such as medication or surgery; and

WHEREAS, since 1978, assisted reproductive technology, and most commonly in vitro fertilization, has provided another solution for many would-be parents; and

WHEREAS, while vital for some patients, in vitro fertilization and similar treatments account for less than three percent of infertility services, and about seven-hundredths of one percent of health care costs in the United States; and

WHEREAS, since 1987, Hawaii has required insurance coverage for the treatment of infertility through in vitro fertilization under certain qualifying conditions; and

WHEREAS, the current law has a number of shortcomings, as it covers only one form of assisted reproductive technologies, in vitro fertilization; provides a one-time only benefit; applies only to an insured's covered spouse; requires fertilization with sperm from the patient's spouse; requires a history of infertility of at least five years; and applies only to a limited number of medical conditions associated with infertility; and

WHEREAS, for those couples who do not meet these requirements – whether for medical or other reasons – the assisted reproductive technologies not covered under the current law may cost $15,000 to $20,000 per procedure, and must often be repeated before a successful live birth; and

WHEREAS, in the nearly twenty-five years since the enactment of the Hawaii law requiring coverage of in vitro fertilization, there have been substantial changes and improvements in assisted reproductive technologies, which could provide couples in Hawaii with additional treatment options appropriate for their specific infertility diagnosis; and

WHEREAS, section 23-51, Hawaii Revised Statutes, requires that "[b]efore any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, there shall be concurrent resolutions passed requesting the auditor to prepare and submit to the legislature a report that assesses both the social and financial effects of the proposed mandated coverage"; and

WHEREAS, section 23-51, Hawaii Revised Statutes, further provides that "[t]he concurrent resolutions shall designate a specific legislative bill that:

(1) Has been introduced in the legislature; and

(2) Includes, at minimum, information identifying the:

(A) Specific health service, disease, or provider that would be covered;

(B) Extent of the coverage;

(D) Limits on utilization, if any; and

(E) Standards of care.

For purposes of this part, mandated health insurance coverage shall not include mandated optionals"; and

WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the Auditor's report; and

WHEREAS, S.B. No. 2909, S.D. 1, Regular Session of 2014, mandates a benefit of three in vitro fertilization cycles or a live birth for all outpatient expenses arising from in vitro fertilization procedures performed on the insured or insured's dependent, for all individual and group accident and health or sickness insurance policies that provide pregnancy-related benefits, effective July 1, 2014; and

WHEREAS, the Legislature believes that infertility procedure coverage, as provided in S.B. No. 2909, S.D. 1, will provide the people of Hawaii with expanded treatment options for assisted reproductive technologies that are appropriate for the specific infertility diagnosis of a patient and that will assist in ensuring adequate and affordable health care services for the people of this State; now, therefore,

BE IT RESOLVED by the Senate of the Twenty-seventh Legislature of the State of Hawaii, Regular Session of 2014, the House of Representatives concurring, that the Auditor is requested to conduct an impact assessment report, pursuant to sections 23-51 and 23-52, Hawaii Revised Statutes, of the social and financial impacts of mandating infertility procedure coverage for all individual and group accident and health or sickness insurance policies that provide pregnancy-related benefits, effective July 1, 2014, as provided in S.B. No. 2909, S.D. 1; and

BE IT FURTHER RESOLVED that the Auditor is requested to include in the impact assessment report:

(1) A survey of other states in the country that have implemented a mandate for expanded infertility in vitro fertilization procedures and examine what the social and financial impact of expanded infertility in vitro fertilization procedures has been in those states;

(2) Whether an expansion of infertility in vitro fertilization procedures would constitute benefits that are in excess of the essential health benefits required for health insurance coverage under the federal Patient Protection and Affordable Care Act of 2010, thus requiring the State to defray such costs;

(3) Any other impacts or requirements of the federal Patient Protection and Affordable Care Act of 2010 if a mandate for expanded infertility in vitro fertilization procedures is enacted in Hawaii;

(4) Research on what is being used as the standard medical definition of "reproductive age" that is best suited for in vitro fertilization procedures and the success rates for different age groups to determine coverage benefit limitations for this covered benefit, including whether different standards of infertility treatments are applied to different age groups in need of infertility treatment;

(5) An examination of current medically necessary standards of care used to determine what types of infertility treatment options are available at a more cost effective savings than in vitro fertilization, which may be best suited for individuals in need of infertility procedures;

(6) An examination of existing technology in infertility procedures and possible future technology for infertility procedures; and

(7) An examination of statutory compliance requirements regarding state mandated benefits across Essential Health Benefits Benchmark plans;

BE IT FURTHER RESOLVED that the Auditor is requested to research the underwriting of the existing Hawaii IVF mandated Essential Health Benefit since its inception, with a look back of 27 years since the passage of the Hawaii IVF mandated benefit; and

BE IT FURTHER RESOLVED that the Auditor is requested to submit findings and recommendations to the Legislature, including any necessary implementing legislation, no later than twenty days prior to the convening of the Regular Session of 2015; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and to the Insurance Commissioner, who, in turn, is requested to transmit copies to each insurer in the State that issues health insurance policies.

Report Title:

Expanded Infertility Procedure Coverage; Mandated Coverage; Health Insurance; Impact Assessment Report; Auditor

THE SENATE	S.C.R. NO.	35
TWENTY-SEVENTH LEGISLATURE, 2014		S.D. 1
STATE OF HAWAII		H.D. 1