HI
Hawaii Senate Bill SB623

Hawaii 2022 Regular Session

Hawaii Senate Bill SB623 Compare Versions

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11 THE SENATE S.B. NO. 623 THIRTY-FIRST LEGISLATURE, 2021 STATE OF HAWAII A BILL FOR AN ACT relating to health care. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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4747 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 four 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 has made it increasingly difficult for insurers to cover abortion care and has assembled a Supreme Court that may restrict abortion access and eliminate the Patient Protection and Affordable Care Act in the near future. The legislature further finds that a host of the Patient 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 already 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 States 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 2022 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2022. (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 2022 when annual information is made available to subscribers or in any other mailing to subscribers, but in no case later than December 31, 2022. (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 2022 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, 2022. (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,] 2021, 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 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) 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.] (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. [(d)] (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) 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. [(e)] (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,] 2021, 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 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) 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.] (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. [(d)] (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) 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. [(e)] (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[.], 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." 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 2022, 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, 2022, 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, 2022. INTRODUCED BY: _____________________________
4848
4949 PART I
5050
5151 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 four 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 has made it increasingly difficult for insurers to cover abortion care and has assembled a Supreme Court that may restrict abortion access and eliminate the Patient Protection and Affordable Care Act in the near future.
5252
5353 The legislature further finds that a host of the Patient 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 already 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.
5454
5555 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 States communities.
5656
5757 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.
5858
5959 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.
6060
6161 PART II
6262
6363 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:
6464
6565 "§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:
6666
6767 (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;
6868
6969 (2) Counseling for sexually transmitted infections, including human immunodeficiency virus and acquired immune deficiency syndrome;
7070
7171 (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;
7272
7373 (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;
7474
7575 (5) Screening and appropriate counseling or interventions for:
7676
7777 (A) Substance abuse, including tobacco and electronic smoking devices, and alcohol; and
7878
7979 (B) Domestic and interpersonal violence;
8080
8181 (6) Screening and appropriate counseling or interventions for mental health screening and counseling, including depression;
8282
8383 (7) Folic acid supplements;
8484
8585 (8) Abortion;
8686
8787 (9) Breastfeeding comprehensive support, counseling, and supplies;
8888
8989 (10) Breast cancer chemoprevention counseling;
9090
9191 (11) Any contraceptive supplies, as specified in section 431:l0A-116.6;
9292
9393 (12) Voluntary sterilization, as a single claim or combined with the following other claims for covered services provided on the same day:
9494
9595 (A) Patient education and counseling on contraception and sterilization; and
9696
9797 (B) Services related to sterilization or the administration and monitoring of contraceptive supplies, including:
9898
9999 (i) Management of side effects;
100100
101101 (ii) Counseling for continued adherence to a prescribed regimen;
102102
103103 (iii) Device insertion and removal; and
104104
105105 (iv) Provision of alternative contraceptive supplies deemed medically appropriate in the judgment of the insured's health care provider;
106106
107107 (13) Pre-exposure prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination; and
108108
109109 (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.
110110
111111 (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.
112112
113113 (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.
114114
115115 (d) Except as otherwise authorized under this section, an insurer shall not impose any restrictions or delays on the coverage required under this section.
116116
117117 (e) This section shall not require a policy of accident and health or sickness insurance to cover:
118118
119119 (1) Experimental or investigational treatments;
120120
121121 (2) Clinical trials or demonstration projects;
122122
123123 (3) Treatments that do not conform to acceptable and customary standards of medical practice; or
124124
125125 (4) Treatments for which there is insufficient data to determine efficacy.
126126
127127 (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:
128128
129129 (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
130130
131131 (2) An in-network provider is unable or unwilling to provide the service, drug, device, product, or procedure in a timely manner.
132132
133133 (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 2022 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2022.
134134
135135 (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.
136136
137137 (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.
138138
139139 (j) A bill or statement for services from any health care provider or insurer shall be sent directly to the person receiving the services.
140140
141141 (k) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6.
142142
143143 §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.
144144
145145 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
146146
147147 (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."
148148
149149 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:
150150
151151 "§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:
152152
153153 (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;
154154
155155 (2) Counseling for sexually transmitted infections, including human immunodeficiency virus and acquired immune deficiency syndrome;
156156
157157 (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;
158158
159159 (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;
160160
161161 (5) Screening and appropriate counseling or interventions for:
162162
163163 (A) Substance abuse, including tobacco and electronic smoking devices, and alcohol; and
164164
165165 (B) Domestic and interpersonal violence;
166166
167167 (6) Screening and appropriate counseling or interventions for mental health screening and counseling, including depression;
168168
169169 (7) Folic acid supplements;
170170
171171 (8) Abortion;
172172
173173 (9) Breastfeeding comprehensive support, counseling, and supplies;
174174
175175 (10) Breast cancer chemoprevention counseling;
176176
177177 (11) Any contraceptive supplies, as specified in section 431:l0A-116.6;
178178
179179 (12) Voluntary sterilization, as a single claim or combined with the following other claims for covered services provided on the same day:
180180
181181 (A) Patient education and counseling on contraception and sterilization; and
182182
183183 (B) Services related to sterilization or the administration and monitoring of contraceptive supplies, including:
184184
185185 (i) Management of side effects;
186186
187187 (ii) Counseling for continued adherence to a prescribed regimen;
188188
189189 (iii) Device insertion and removal; and
190190
191191 (iv) Provision of alternative contraceptive supplies deemed medically appropriate in the judgment of the insured's dependent's health care provider;
192192
193193 (13) Pre-exposure prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination; and
194194
195195 (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.
196196
197197 (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.
198198
199199 (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.
200200
201201 (d) Except as otherwise authorized under this section, an insurer shall not impose any restrictions or delays on the coverage required under this section.
202202
203203 (e) This section shall not require a policy of accident and health or sickness insurance to cover:
204204
205205 (1) Experimental or investigational treatments;
206206
207207 (2) Clinical trials or demonstration projects;
208208
209209 (3) Treatments that do not conform to acceptable and customary standards of medical practice; or
210210
211211 (4) Treatments for which there is insufficient data to determine efficacy.
212212
213213 (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:
214214
215215 (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
216216
217217 (2) An in-network provider is unable or unwilling to provide the service, drug, device, product, or procedure in a timely manner.
218218
219219 (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 2022 when annual information is made available to subscribers or in any other mailing to subscribers, but in no case later than December 31, 2022.
220220
221221 (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.
222222
223223 (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.
224224
225225 (j) A bill or statement for services from any health care provider or insurer shall be sent directly to the person receiving the services.
226226
227227 (k) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6.
228228
229229 §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.
230230
231231 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
232232
233233 (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."
234234
235235 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:
236236
237237 "§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:
238238
239239 (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;
240240
241241 (2) Counseling for sexually transmitted infections, including human immunodeficiency virus and acquired immune deficiency syndrome;
242242
243243 (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;
244244
245245 (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;
246246
247247 (5) Screening and appropriate counseling or interventions for:
248248
249249 (A) Substance abuse, including tobacco and electronic smoking devices, and alcohol; and
250250
251251 (B) Domestic and interpersonal violence;
252252
253253 (6) Screening and appropriate counseling or interventions for mental health screening and counseling, including depression;
254254
255255 (7) Folic acid supplements;
256256
257257 (8) Abortion;
258258
259259 (9) Breastfeeding comprehensive support, counseling, and supplies;
260260
261261 (10) Breast cancer chemoprevention counseling;
262262
263263 (11) Any contraceptive supplies, as specified in section 431:l0A-116.6;
264264
265265 (12) Voluntary sterilization, as a single claim or combined with the following other claims for covered services provided on the same day:
266266
267267 (A) Patient education and counseling on contraception and sterilization; and
268268
269269 (B) Services related to sterilization or the administration and monitoring of contraceptive supplies, including:
270270
271271 (i) Management of side effects;
272272
273273 (ii) Counseling for continued adherence to a prescribed regimen;
274274
275275 (iii) Device insertion and removal; and
276276
277277 (iv) Provision of alternative contraceptive supplies deemed medically appropriate in the judgment of the subscriber's or member's health care provider;
278278
279279 (13) Pre-exposure prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination; and
280280
281281 (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.
282282
283283 (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.
284284
285285 (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.
286286
287287 (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.
288288
289289 (e) This section shall not require an individual or group hospital or medical service plan contract to cover:
290290
291291 (1) Experimental or investigational treatments;
292292
293293 (2) Clinical trials or demonstration projects;
294294
295295 (3) Treatments that do not conform to acceptable and customary standards of medical practice; or
296296
297297 (4) Treatments for which there is insufficient data to determine efficacy.
298298
299299 (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:
300300
301301 (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
302302
303303 (2) An in-network provider is unable or unwilling to provide the service, drug, device, product, or procedure in a timely manner.
304304
305305 (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 2022 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, 2022.
306306
307307 (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.
308308
309309 (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.
310310
311311 (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.
312312
313313 (k) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6.
314314
315315 §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.
316316
317317 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
318318
319319 (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."
320320
321321 SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
322322
323323 "§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.
324324
325325 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
326326
327327 (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."
328328
329329 SECTION 6. Section 431:10A-116.6, Hawaii Revised Statutes, is amended to read as follows:
330330
331331 "§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,] 2021, 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:
332332
333333 (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;
334334
335335 (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;
336336
337337 (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
338338
339339 (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.
340340
341341 [(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.
342342
343343 (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:
344344
345345 (1) Use of brands covered has resulted in an adverse drug reaction; or
346346
347347 (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.]
348348
349349 (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.
350350
351351 (c) Except as otherwise provided by this section, an insurer shall not impose any restrictions or delays on the coverage required by this section.
352352
353353 (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:
354354
355355 (1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
356356
357357 (2) Contraception that is necessary to preserve the life or health of an insured.
358358
359359 [(d)] (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.
360360
361361 (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.
362362
363363 (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.
364364
365365 [(e)] (h) For purposes of this section:
366366
367367 "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.
368368
369369 "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.
370370
371371 [(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.]"
372372
373373 SECTION 7. Section 431:10A-116.7, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:
374374
375375 "(g) For purposes of this section:
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377377 "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.
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379379 "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."
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381381 SECTION 8. Section 432:1-604.5, Hawaii Revised Statutes, is amended to read as follows:
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383383 "§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,] 2021, 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:
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385385 (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;
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387387 (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;
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389389 (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
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391391 (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.
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393393 [(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.
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395395 (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:
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397397 (1) Use of brands covered has resulted in an adverse drug reaction; or
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399399 (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.]
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401401 (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.
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403403 (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.
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405405 (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:
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407407 (1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
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409409 (2) Contraception that is necessary to preserve the life or health of a subscriber or member.
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411411 [(d)] (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.
412412
413413 (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.
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415415 (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.
416416
417417 [(e)] (h) For purposes of this section:
418418
419419 "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.
420420
421421 "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.
422422
423423 [(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.]"
424424
425425 SECTION 9. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
426426
427427 "§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."
428428
429429 PART III
430430
431431 SECTION 10. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
432432
433433 "§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.
434434
435435 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
436436
437437 (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."
438438
439439 PART IV
440440
441441 SECTION 11. No later than twenty days prior the convening of the regular session of 2022, 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.
442442
443443 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.
444444
445445 SECTION 13. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
446446
447447 SECTION 14. This Act shall take effect on January 1, 2022, 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, 2022.
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451451 INTRODUCED BY: _____________________________
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453453 INTRODUCED BY:
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455455 _____________________________
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461461 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.
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467467 Report Title:
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469469 Health Care; Insurance
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473473 Description:
474474
475475 Requires health insurance coverage for various sexual and reproductive health care services.
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483483 The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.