Bill Text: HI HB2676 | 2020 | Regular Session | Introduced
Bill Title: Relating To Health Care.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2020-02-27 - The committee(s) on FIN recommend(s) that the measure be deferred. [HB2676 Detail]
Download: Hawaii-2020-HB2676-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
2676 |
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THIRTIETH LEGISLATURE, 2020 |
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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, advocating the importance of access to reproductive health care without discrimination, and implementing forward-thinking reproductive health care policy. However, gaps in coverage and care still exist, and Hawaii's benefits and protections are constantly under attack by a hostile federal administration bent on repealing or undercutting the federal Patient Protection and Affordable Care Act of 2010 and, in particular, access to sexual and reproductive health care benefits and protections.
The legislature finds that access to reproductive health care is critical for the health and economic security of all of Hawaii's people. Research shows that for every one dollar in public spending on reproductive health and family planning services, states save seven dollars in medicaid costs for pregnancy, labor and delivery, and children's health care. Ensuring that Hawaii's people receive comprehensive client-centered and culturally-sensitive sexual and reproductive health care makes good economic sense and improves the overall health of our communities and our State.
The legislature concludes that in order to safeguard access to abortion, to solidify the essential health benefits that have changed thousands of lives, and to improve overall access to care, it is vital to preserve certain important aspects of the Patient Protection and Affordable Care Act and expand access to care for residents of Hawaii.
Accordingly, the purpose of this Act is to ensure comprehensive coverage for the full spectrum of sexual and reproductive health care services, including family planning and abortion, for all of Hawaii's people.
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, a well-woman visit, where appropriate,
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 42
United States Code section 300gg-13, as identified by the federal Preventive
Services Task Force or the Health Resources and Services Administration of the
federal Department of Health and Human Services, as of January 1, 2018.
(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 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 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 2021
when annual information is made available to policyholders or in any other
mailing to policyholders, but in no case later than December 31, 2021.
(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‑102.5.
(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 any
subscriber or any dependent of the subscriber 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, a well-woman visit, where appropriate, 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 electric 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 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 42
United States Code section 300gg-13, as identified by the federal Preventive
Services Task Force or the Health Resources and Services Administration of the
federal Department of Health and Human Services, as of January 1, 2018.
(b) An insurer shall not impose any cost-sharing
requirements, including copayments, coinsurance, or deductibles, on a
subscriber 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 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 subscriber's ability to claim tax-exempt
contributions and withdrawals from the subscriber's health savings account
under 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 subscriber 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 subscribers
and shall be transmitted to subscribers beginning with calendar year 2021 when
annual information is made available to subscribers or in any other mailing to
subscribers, but in no case later than December 31, 2021.
(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‑102.5.
(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, a well-woman visit, where appropriate, shall include 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 42
United States Code section 300gg-13, as identified by the federal Preventive
Services Task Force or the Health Resources and Services Administration of the
federal Department of Health and Human Services, as of January 1, 2018.
(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 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 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 2021 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, 2021.
(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-102.5.
(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, or
procedures covered by section 432:l-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: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 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,] 2020, 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[.];
provided that:
(1) If there is a
therapeutic equivalent of a contraceptive supply approved by the federal
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-thecounter sale that are approved by the federal 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) 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)] (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.
(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.
[(e)] (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.
[(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,] 2020, 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[.]; provided
that:
(1) If there is a
therapeutic equivalent of a contraceptive supply approved by the federal 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-thecounter sale that are approved by the federal
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) 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)] (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.
(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.
[(e)] (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 Food and Drug Administration-approved contraceptive drugs or devices
used to prevent unwanted pregnancy[.], 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.
[(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 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."
SECTION 10. 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 part, and of any actions taken by the insurance commissioner to enforce compliance with this part no later than twenty days prior to the convening of the regular session of 2021.
PART III
SECTION 11. 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 12. In codifying the new sections added by sections 2, 3, 4, 5, and 11 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 March 15, 2021, 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 March 15, 2021.
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Report Title:
Health Insurance; Required Benefits; Covered Benefits; Reproductive Health Care
Description:
Requires health insurers, mutual benefit societies, and health maintenance organizations to provide coverage for a comprehensive category of reproductive health services, drugs, devices, products, and procedures. Prohibits discrimination in the provision of reproductive health care services. Effective 3/15/2021.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
