Bill Text: HI HB687 | 2018 | Regular Session | Amended
Bill Title: Relating To Insurance.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2018-02-16 - 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) DeCoite, Ing, Nakamura, Onishi, Woodson excused (5). [HB687 Detail]
Download: Hawaii-2018-HB687-Amended.html
|
HOUSE OF REPRESENTATIVES |
H.B. NO. |
687 |
|
TWENTY-NINTH LEGISLATURE, 2017 |
H.D. 2 |
|
|
STATE OF HAWAII |
|
|
|
|
|
|
|
|
||
|
|
||
A BILL FOR AN ACT
RELATING TO INSURANCE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
SECTION 1.
Critically ill patients in Hawaii may require treatment on the
continental United States. The cost of
transportation by an air ambulance can be a significant financial burden that
may not be covered by insurance.
Commercial flights are not an option because the patient requires life
supporting equipment and a medical support team.
For patients requiring transportation to
the continental United States, their only options are to mortgage their homes,
drain retirement savings, borrow from family or friends, or establish a
Gofundme.com campaign to raise funds.
During the time that a family is fundraising for a sick loved one, the
patient's condition can deteriorate rapidly and reduce the chance of
recovery. In addition, if the delay is
too great, then the accepting facility may give the patient's bed to another
individual and the patient is forced to find another accepting facility.
The legislature finds that Medicaid
currently covers the cost of transportation for Hawaii's most needy families,
but those who are middle-income earners and working full-time do not receive
coverage for the cost of transportation to the continental United States. The legislature also finds that due to
Hawaii's unique position in the middle of the Pacific Ocean, residents deserve
to receive life-saving medical care that is not available in the State.
The purpose of this part is to ensure the
provision of quality health care by requiring insurance coverage for the costs
of medically necessary transportation to the continental United States for
qualifying patients.
SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:
"§431:10A- Qualifying patients; transportation cost
coverage. Notwithstanding any
law to the contrary, each policy of accident and health or sickness insurance
issued or renewed in this State after December 31, 2018, providing coverage for
health care, except for policies that only provide coverage for specified
diseases or other limited benefit coverage, shall provide coverage for the costs
of medically necessary transportation from the State to the continental United
States for qualifying patients for the purpose of obtaining treatment.
For purposes of this section,
"qualifying patient" is defined by a medical provider's team as a patient
that meets all of the following criteria:
(1) The patient displays a high risk of
imminent death despite optimal available treatment in the State;
(2) The patient has a diagnosis of a
potentially reversible disease or is a potential candidate for a heart or lung,
or both, transplant, destination ventricular assist device, or total artificial
heart;
(3) The medically necessary out-of-state treatment
as defined in chapter 432E, for the patient is not available in the State;
(4) The patient shall not have any known
absolute contraindications to the out-of-state treatment being sought;
(5) The patient does not have end stage
dementia, anoxic brain injury, terminal cancer, or a premorbid condition with a
short term expected survival; and
(6) The patient is not being transported for
the sole purpose of cancer treatment or bone marrow transplant."
SECTION 3.
Chapter 432, Hawaii Revised Statutes, is amended by adding a new section
to article I to be appropriately designated and to read as follows:
"§432:1- Qualifying patients; transportation cost
coverage. Notwithstanding any
law to the contrary, each hospital and medical service plan contract issued or
renewed in this State after December 31, 2018, shall provide coverage for the
costs of medically necessary transportation from the State to the continental
United States for qualifying patients for the purpose of obtaining treatment.
For purposes of this section,
"qualifying patient" is defined by a medical provider's team as a patient that meets all
of the following criteria:
(1) The patient displays a high risk of
imminent death despite optimal available treatment in the State;
(2) The patient has a diagnosis of a
potentially reversible disease or is a potential candidate for a heart or lung,
or both, transplant, destination ventricular assist device, or total artificial
heart;
(3) The medically necessary out-of-state treatment
as defined in chapter
432E, for the patient is not available in the State;
(4) The patient shall not have any known
absolute contraindications to the out-of-state treatment being sought;
(5) The patient does not have end stage
dementia, anoxic brain injury, terminal cancer, or a premorbid condition with a
short term expected survival; and
(6) The patient is not being transported for
the sole purpose of cancer treatment or bone marrow transplant."
SECTION 4. 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-140, [and] 431:10A-134, and
431:10A- , and chapter 431M."
SECTION 5. Notwithstanding section 432D-23, Hawaii Revised Statutes, the coverage and benefits for the medically necessary transportation costs for qualifying patients provided by health maintenance organizations under section 4 of this part shall apply to all policies, contracts, plans, or agreements issued or renewed in this State by a health maintenance organization after December 31, 2018.
PART II
SECTION 6. The purpose of this part is to require the auditor to conduct a study to assess the social and financial effects of requiring health insurers, hospital and medical services plans, and health maintenance organizations to provide coverage for the costs of medically necessary transportation to the continental United States for medical treatment for qualifying patients
SECTION 7. (a) The auditor shall conduct a study to assess the impact of the social and financial effects of requiring health insurers, hospital and medical services plans, and health maintenance organizations to provide coverage for the costs of medically necessary transportation to the continental United States for medical treatment for qualifying patients, as provided in part I of this Act.
(b) Pursuant to section 23-52, Hawaii Revised Statutes, in determining the social impact of the proposed mandate of health coverage, the study shall include:
(1) The extent to which the treatment or service is generally utilized by a significant portion of the population;
(2) The extent to which such insurance coverage is already generally available;
(3) If coverage is not generally available, the extent to which the lack of coverage results in persons being unable to obtain necessary health care treatment;
(4) If the coverage is not generally available, the extent to which the lack of coverage results in unreasonable financial hardship on those persons needing treatment;
(5) The level of public demand for the treatment or service;
(6) The level of public demand for individual or group insurance coverage of the treatment or service;
(7) The level of interest of collective bargaining organizations in negotiating privately for inclusion of this coverage in group contracts;
(8) The impact of providing coverage for the treatment or service (such as morbidity, mortality, quality of care, change in practice patterns, provider competition, or related items); and
(9) The impact of any other indirect costs upon the costs and benefits of coverage as may be deemed necessary by the auditor.
(c) Pursuant to section 23-52, Hawaii Revised Statutes, in determining the financial impact of the proposed mandate of health coverage, the study shall include:
(1) The extent to which insurance coverage of the kind proposed would increase or decrease the cost of the treatment or service;
(2) The extent to which the proposed coverage might increase the use of the treatment or service;
(3) The extent to which the mandated treatment or service might serve as an alternative for more expensive treatment or service;
(4) The extent to which insurance coverage of the health care service or provider can be reasonably expected to increase or decrease the insurance premium and administrative expenses of policyholders; and
(5) The impact of this coverage on the total cost of health care.
(d) The auditor shall submit findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2019.
PART III
SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 9. This Act shall take effect on July 1, 3000.
Report Title:
Insurance Coverage; Transportation Costs; Qualifying Patients; Mandated Coverage; Auditor Study
Description:
Requires insurance coverage after December 31, 2018, for the costs of medically necessary transportation to the continental United States for medical treatment for qualifying patients. Requires the auditor to conduct a study to assess the social and financial impacts of mandating certain health insurers and plans to provide coverage for the costs of medically necessary transportation to the continental United States for medical treatment for qualifying patients. (HB687 HD2)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
