| 43 | | - | WHEREAS, certain cancers and cancer treatments or procedures may affect a person's ability to procreate by damaging the person's reproductive organs or otherwise reducing fertility; and WHEREAS, due to the high costs of fertility preservation procedures and the narrow window to obtain services, the procedure is unattainable for many people; and WHEREAS, mandated health care coverage for fertility preservation procedures would allow persons who are diagnosed with cancer, and who will undergo treatment that may affect their fertility, to have the opportunity to have a child in the future; and WHEREAS, the Legislature adopted House Concurrent Resolution No. 9, S.D. 1, Regular Session of 2012, requesting the Auditor to assess the social and financial effects of mandating health insurance coverage for fertility preservation procedures for persons of reproductive age who have been diagnosed with cancer and will undergo treatment that may adversely affect fertility as further described by House Bill No. 2105 (Regular Session of 2012); and WHEREAS, in October 2012, the Auditor issued its Report No. 12-09, entitled "Mandatory Health Insurance Coverage for Fertility Preservation Procedures for People of Reproductive Age Diagnosed with Cancer"; and WHEREAS, at the time the report was written, no state required insurance coverage for infertility treatments for people who may become infertile as a result of cancer treatments; further, the Auditor found that insurance coverage for the two fertility preservation procedures proposed in H.B. No. 2105, was not generally available in Hawaii or in other states; and WHEREAS, the report found that "there is insufficient data to assess the social and financial impacts of mandating insurance coverage. Individuals diagnosed with cancer, who may want to preserve their reproductive ability, must seek the service on their own and bear the full costs, which could be upwards of $10,000. . . . [B]ut we conclude that the number of people generally utilizing the procedures is unknown and the level of public demand is low"; and WHEREAS, since that time, more fertility preservation options have been developed and improved and are now recognized as part of the standard of care in oncology treatment; and WHEREAS, due to significant advances in cancer treatment over the past generation, cancer patients eligible for these treatments, meaning patients ages zero to forty-five, have extremely good chances of survival, often above eighty percent, and therefore deserve mitigation of side effects such as infertility that could adversely impact their subsequent quality of life; and WHEREAS, in the past four years, eleven states have recognized the need for this coverage and have therefore enacted laws mandating insurance coverage for fertility preservation procedures for cancer patients and others facing potential infertility as result of medical treatment, which include: California, Colorado, Connecticut, Delaware, Illinois, Maryland, New Hampshire, New Jersey, New York, Rhode Island, and Utah; and WHEREAS, now, with experience in other states of various size, geography, and demographics; published, detailed reports from California and Connecticut; and potentially more fertility preservation options available now than were available ten years ago, this body finds that the Auditor should be able to evaluate additional experiential data and better assess the social and financial impacts of mandating insurance coverage for fertility preservation procedures for those who have been diagnosed with cancer and whose cancer or cancer treatment may adversely affect their fertility; and WHEREAS, House Bill No. 2242 and Senate Bill No. 3308, introduced during the Regular Session of 2022, require insurers, mutual benefit societies, and health maintenance organizations to provide coverage for fertility preservation procedures for those who have been diagnosed with cancer or other medical condition or disease and whose cancer or cancer treatment may adversely affect their fertility; and WHEREAS, pursuant to section 23-51, Hawaii Revised Statutes, before any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, concurrent resolutions shall be passed that designate a specific legislative bill for the Auditor to review and prepare a report for submission to the Legislature that assesses both the social and financial effects of the proposed mandated coverage under that legislative bill; and WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the State Auditor's report; now, therefore, BE IT RESOLVED by the Senate of the Thirty-first Legislature of the State of Hawaii, Regular Session of 2022, the House of Representatives concurring, that the Auditor is requested to assess, in accordance with sections 23-51 and 23-52, Hawaii Revised Statutes, the social and financial effects of mandating health insurance coverage for fertility preservation procedures for certain persons who have been diagnosed with cancer and whose cancer or cancer treatment may adversely affect the person's fertility, as provided in House Bill No. 2242 and Senate Bill No. 3308, Regular Session of 2022; and BE IT FURTHER RESOLVED that the Auditor is requested to include in the impact assessment report a survey of other states in the United States that have implemented a mandate for cryopreservation benefits for those diagnosed with cancer and to examine what the social and financial impact has been in those states; and BE IT FURTHER RESOLVED that the Auditor is requested to research whether the proposed cryopreservation coverage for those diagnosed with cancer constitutes benefits that are in excess of the essential health benefits, thus requiring the State to defray such costs; and BE IT FURTHER RESOLVED that the Auditor is requested to research what is being used as the standard medical definition of "reproductive age" that is best suited for the proposed cryopreservation procedures for those diagnosed with cancer and to examine the success rates for the different age groups to determine coverage benefit limitations for this proposed covered benefit, including an examination of whether different standards of infertility treatments are applied to different age groups for those diagnosed with cancer; and BE IT FURTHER RESOLVED that the Auditor is requested to research public entities (including but not limited to Medicare and Medicaid) and private entities that provide the proposed coverage for cryopreservation procedures for those diagnosed with cancer and to determine what is currently being used as a standard for coverage, including what, if any, cost limitations are placed on this coverage benefit; and BE IT FURTHER RESOLVED that the Auditor is requested to examine current medically necessary standards of care used to determine what types of infertility treatment options are available, at a more cost-effective savings than the proposed cryopreservation procedures, which may be best suited for individuals diagnosed with cancer, and to examine the existing technology in infertility procedures and possible future technology; and BE IT FURTHER RESOLVED that the Auditor is requested to examine current scientific studies and current medical literature relating to the efficacy of the proposed cryopreservation procedures for those diagnosed with cancer; and BE IT FURTHER RESOLVED that the Auditor is requested to examine whether the scope of coverage for those "diagnosed with a cancer that may, or whose treatment may, adversely affect the fertility of the insured" is limited to medically necessary fertility preservation treatments for "iatrogenic infertility", meaning an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes; and BE IT FURTHER RESOLVED that the Auditor is requested to research the ethical and legal issues surrounding the rights and entitlements with respect to the cryopreserved material, as well as the legal rights of offspring conceived posthumously, including contract remedies (for example, cryobank agreements) to address the storage and disposition of the cryopreserved material, and to consider the following: (1) How long will the cryopreserved material be preserved; (2) When and how will the cryopreserved material be destroyed; (3) Upon a donor's death: (A) Who has ownership rights of the cryopreserved material; (B) Who pays for the storage of the cryopreserved material; and (C) If the donor is married at the time, whether the spouse can use the cryopreserved material to have a baby after the donor's death; (4) What will happen to the cryopreserved material if the donor and their spouse separate; and (5) Whether others can use cryopreserved material posthumously and who has the legal decision-making authority as to the storage or disposal of the cryopreserved material posthumously; and BE IT FURTHER RESOLVED that the Auditor is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2023; and BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and Insurance Commissioner who, in turn, is requested to transmit copies to each organization that issues health insurance policies in the State that may be affected by this Concurrent Resolution. Report Title: Auditor; Impact Study; Fertility Preservation Procedures; Mandatory Coverage |
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| 45 | + | WHEREAS, certain cancers and cancer treatments or procedures may affect a person's ability to procreate by damaging the person's reproductive organs or otherwise reducing fertility; and WHEREAS, due to the high costs of fertility preservation procedures and the narrow window to obtain services, the procedure is unattainable for many people; and WHEREAS, mandated health care coverage for fertility preservation procedures would allow persons who are diagnosed with cancer, and who will undergo treatment that may affect their fertility, to have the opportunity to have a child in the future; and WHEREAS, the Legislature adopted House Concurrent Resolution No. 9, S.D. 1, Regular Session of 2012, requesting the Auditor to assess the social and financial effects of mandating health insurance coverage for fertility preservation procedures for persons of reproductive age who have been diagnosed with cancer and will undergo treatment that may adversely affect fertility as further described by House Bill No. 2105 (Regular Session of 2012); and WHEREAS, in October 2012, the Auditor issued its Report No. 12-09, entitled "Mandatory Health Insurance Coverage for Fertility Preservation Procedures for People of Reproductive Age Diagnosed with Cancer"; and WHEREAS, at the time the report was written, no state required insurance coverage for infertility treatments for people who may become infertile as a result of cancer treatments; further, the Auditor found that insurance coverage for the two fertility preservation procedures proposed in H.B. No. 2105, was not generally available in Hawaii or in other states; and WHEREAS, the report found that "there is insufficient data to assess the social and financial impacts of mandating insurance coverage. Individuals diagnosed with cancer, who may want to preserve their reproductive ability, must seek the service on their own and bear the full costs, which could be upwards of $10,000. . . . [B]ut we conclude that the number of people generally utilizing the procedures is unknown and the level of public demand is low"; and WHEREAS, since that time, more fertility preservation options have been developed and improved and are now recognized as part of the standard of care in oncology treatment; and WHEREAS, due to significant advances in cancer treatment over the past generation, cancer patients eligible for these treatments, meaning patients ages zero to forty-five, have extremely good chances of survival, often above eighty percent, and therefore deserve mitigation of side effects such as infertility that will adversely impact their subsequent quality of life; and WHEREAS, in the past four years, eleven states have recognized the need for this coverage and have therefore enacted laws mandating insurance coverage for fertility preservation procedures for cancer patients and others facing potential infertility as result of medical treatment: California, Colorado, Connecticut, Delaware, Illinois, Maryland, New Hampshire, New Jersey, New York, Rhode Island, and Utah; and WHEREAS, now, with experience in other states of various size, geography, and demographics; published, detailed reports from California and Connecticut; and potentially more fertility preservation options available now than were available ten years ago, this body finds that the Auditor should be able to evaluate additional experiential data and better assess the social and financial impacts of mandating insurance coverage for fertility preservation procedures for those who have been diagnosed with cancer and whose cancer or cancer treatment may adversely affect their fertility; and WHEREAS, House Bill No. 2242 and Senate Bill No. 3308, introduced during the Regular Session of 2022, require insurers, mutual benefit societies, and health maintenance organizations to provide coverage for fertility preservation procedures for those who have been diagnosed with cancer or other medical condition or disease and whose cancer or cancer treatment may adversely affect their fertility; and WHEREAS, pursuant to section 23-51, Hawaii Revised Statutes, before any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, concurrent resolutions shall be passed that designate a specific legislative bill for the Auditor to review and prepare a report for submission to the Legislature that assesses both the social and financial effects of the proposed mandated coverage under that legislative bill; and WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the State Auditor's report; now, therefore, BE IT RESOLVED by the Senate of the Thirty-first Legislature of the State of Hawaii, Regular Session of 2022, the House of Representatives concurring, that the Auditor is requested to assess, in accordance with sections 23-51 and 23-52, Hawaii Revised Statutes, the social and financial effects of mandating health insurance coverage for fertility preservation procedures for certain persons who have been diagnosed with cancer and whose cancer or cancer treatment may adversely affect the person's fertility, as provided in House Bill No. 2242 and Senate Bill No. 3308, Regular Session of 2022; and BE IT FURTHER RESOLVED that the Auditor is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2023; and BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and Insurance Commissioner who, in turn, is requested to transmit copies to each organization that issues health insurance policies in the State that may be affected by this Concurrent Resolution. OFFERED BY: _____________________________ Report Title: Auditor; Impact Study; Fertility Preservation Procedures; Mandatory Coverage |
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