Bill Text: HI HB309 | 2021 | Regular Session | Introduced
Bill Title: Relating To Health.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2021-02-18 - Report adopted. referred to the committee(s) on FIN as amended in HD 2 with none voting aye with reservations; none voting no (0) and Representative(s) Gates excused (1). [HB309 Detail]
Download: Hawaii-2021-HB309-Introduced.html
HOUSE OF REPRESENTATIVES |
H.B. NO. |
309 |
THIRTY-FIRST LEGISLATURE, 2021 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HEALTH.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Section 431:10A-116, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-116 Coverage for specific services. Every person insured under a policy of accident and health or sickness insurance delivered or issued for delivery in this State shall be entitled to the reimbursements and coverages specified below:
(1) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any visual or optometric service, which is within the lawful scope of practice of a duly licensed optometrist, the person entitled to benefits or the person performing the services shall be entitled to reimbursement whether the service is performed by a licensed physician or by a licensed optometrist. Visual or optometric services shall include eye or visual examination, or both, or a correction of any visual or muscular anomaly, and the supplying of ophthalmic materials, lenses, contact lenses, spectacles, eyeglasses, and appurtenances thereto;
(2) Notwithstanding any provision to the contrary, for all policies, contracts, plans, or agreements issued on or after May 30, 1974, whenever provision is made for reimbursement or indemnity for any service related to surgical or emergency procedures, which is within the lawful scope of practice of any practitioner licensed to practice medicine in this State, reimbursement or indemnification under the policy, contract, plan, or agreement shall not be denied when the services are performed by a dentist acting within the lawful scope of the dentist's license;
(3) Notwithstanding any provision to the contrary, whenever the policy provides reimbursement or payment for any service, which is within the lawful scope of practice of a psychologist licensed in this State, the person entitled to benefits or performing the service shall be entitled to reimbursement or payment, whether the service is performed by a licensed physician or licensed psychologist;
(4) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article 1 shall provide coverage for screening by low-dose mammography for occult breast cancer as follows:
(A) For
women between the ages of thirty-five and thirty-nine, a baseline mammogram;
[(A)] (B) For
women forty years of age and older, an annual mammogram; and
[(B)] (C) For a woman
of any age with an above-average risk for breast cancer as determined by the
use of a risk-factor modeling tool, a history of breast cancer, or
whose mother or sister has had a history of breast cancer, [a] an annual
mammogram [upon the recommendation of the woman's physician].
The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements.
For the purpose of this
paragraph, the term "low-dose mammography" means the x-ray
examination of the breast using equipment dedicated specifically for
mammography, including but not limited to the x-ray tube, filter, compression
device, screens, films, and cassettes, with an average radiation exposure
delivery of less than one rad mid-breast, with two views for each breast. An insurer may provide the services required
by this paragraph through contracts with providers; provided that the contract
is determined to be a cost-effective means of delivering the services without
sacrifice of quality and meets the approval of the director of health; [and]
(A) For women age thirty or older, a formal
risk factor screening assessment informed by any readily available risk factor modeling
tool; and
(B) For any women regardless of age, any
additional supplemental imaging, such as breast magnetic resonance imaging, digital
breast tomosynthesis, or ultrasound, as deemed medically necessary by an applicable
American College of Radiology guideline. For purposes of this paragraph, "digital breast
tomosynthesis" means a radiologic procedure that involves the acquisition of
a projection of images over the stationary breast to produce cross-sectional digital
three-dimensional images of the breast; and
[(5)] (6) (A) (i) Notwithstanding
any provision to the contrary, whenever a policy, contract, plan, or agreement
provides coverage for the children of the insured, that coverage shall also
extend to the date of birth of any newborn child to be adopted by the insured;
provided that the insured gives written notice to the insurer of the insured's
intent to adopt the child prior to the child's date of birth or within thirty
days after the child's birth or within the time period required for enrollment
of a natural born child under the policy, contract, plan, or agreement of the
insured, whichever period is longer; provided further that if the adoption
proceedings are not successful, the insured shall reimburse the insurer for any
expenses paid for the child; and
(ii) Where notification has not been received by the insurer prior to the child's birth or within the specified period following the child's birth, insurance coverage shall be effective from the first day following the insurer's receipt of legal notification of the insured's ability to consent for treatment of the infant for whom coverage is sought; and
(B) When the insured is a member of a health maintenance organization, coverage of an adopted newborn is effective:
(i) From the date of birth of the adopted newborn when the newborn is treated from birth pursuant to a provider contract with the health maintenance organization, and written notice of enrollment in accord with the health maintenance organization's usual enrollment process is provided within thirty days of the date the insured notifies the health maintenance organization of the insured's intent to adopt the infant for whom coverage is sought; or
(ii) From the first day following receipt by the health maintenance organization of written notice of the insured's ability to consent for treatment of the infant for whom coverage is sought and enrollment of the adopted newborn in accord with the health maintenance organization's usual enrollment process if the newborn has been treated from birth by a provider not contracting or affiliated with the health maintenance organization. "
SECTION 2. Section 432:1-605, Hawaii Revised Statutes, is amended to read as follows:
"§432:1-605 [Mammogram] Breast
cancer screening[.]; mammography. (a)
Notwithstanding any provision to the contrary, each policy, contract,
plan, or agreement issued on or after February 1, 1991, except for policies
that only provide coverage for specified diseases or other limited benefit
coverage, but including policies issued by companies subject to chapter 431,
article 10A, part II and chapter 432, article 1 shall provide coverage for
screening by low-dose mammography for occult breast cancer as follows:
(1) For women between
the ages of thirty-five and thirty-nine, a baseline mammogram;
[(1)] (2) For
women forty years of age and older, an annual mammogram; and
[(2)] (3) For
a woman of any age with an above-average risk for breast cancer as determined
by the use of a risk-factor modeling tool, a history of breast cancer,
or whose mother or sister has had a history of breast cancer, [a] an annual
mammogram [upon the recommendation of the woman's physician].
(b) Notwithstanding any provision to the contrary,
each policy, contract, plan, or agreement issued on or after January 1, 2022,
except for policies that only provide coverage for specified diseases or other
limited benefit coverage, but including policies issued by companies subject to
chapter 431, article 10A, part II and chapter 432, article 1 shall provide as additional
breast cancer screening coverage:
(1) For women age thirty
or older, a formal risk factor screening assessment informed by any readily available
risk factor modeling tool; and
(2) For any women regardless
of age, any additional supplemental imaging, such as breast magnetic resonance imaging,
digital breast tomosynthesis, or ultrasound, as deemed medically necessary by an
applicable American College of Radiology guideline.
[(b)] (c) The services provided in [subsection] subsections
(a) and (b) are subject to any coinsurance provisions that may be in
force in these policies, contracts, plans, or agreements.
[(c)] (d) For purposes of this section[,]:
"[low-dose] Low-dose
mammography" means the x-ray examination of the breast using equipment
dedicated specifically for mammography, including but not limited to the x-ray
tube, filter, compression device, screens, films, and cassettes, with an
average radiation exposure delivery of less than one rad mid-breast, with two
views for each breast.
"Digital breast tomosynthesis"
means a radiologic procedure that involves the acquisition of a projection of images
over the stationary breast to produce cross-sectional digital three-dimensional
images of the breast.
[(d)] (e) An insurer may provide the services required
by this section through contracts with providers; provided that the contract is
determined to be a cost-effective means of delivering the services without
sacrifice of quality and meets the approval of the director of health. "
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect upon its approval.
INTRODUCED BY: |
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Report Title:
Breast Cancer; Screening; Annual Mammography; Risk Factor Screening
Description:
Expands coverage of breast cancer screening and imaging to include risk factor screening, additional and supplemental imaging, and baseline mammograms for women between the ages of thirty-five and thirty-nine.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.