HI
Hawaii Senate Bill SB892

Hawaii 2023 Regular Session

Hawaii Senate Bill SB892 Compare Versions

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11 THE SENATE S.B. NO. 892 THIRTY-SECOND LEGISLATURE, 2023 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 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 made it increasingly difficult for insurers to cover abortion care and assembled a Supreme Court that overturned the right to abortion access and that may eliminate the Patient Protection and Affordable Care Act in the near future. The legislature further finds that a host of the 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 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) Except as otherwise authorized under this section, an insurer shall not impose any restrictions or delays on the coverage required under this section. (c) 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. (d) 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 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. (e) 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 2024 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2024. (f) 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. (g) 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. (h) A bill or statement for services from any health care provider or insurer shall be sent directly to the person receiving the services. (i) 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) Except as otherwise authorized under this section, an insurer shall not impose any restrictions or delays on the coverage required under this section. (c) 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. (d) 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 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. (e) 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 2024 when annual information is made available to subscribers or in any other mailing to subscribers, but in no case later than December 31, 2024. (f) 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. (g) 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. (h) A bill or statement for services from any health care provider or insurer shall be sent directly to the person receiving the services. (i) 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) 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. (c) 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. (d) 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 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. (e) 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 2024 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, 2024. (f) 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. (g) 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. (h) 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. (i) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6. §432:1-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,] 2024, 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[. (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.] ; 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 otherwise provided by this section, an insurer shall not impose any restrictions or delays on the coverage required by this section. (c) 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) 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. (e) 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. (f) 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. (g) For purposes of this section: "Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy. "Contraceptive supplies" means all United States Food and Drug Administration-approved contraceptive drugs [or], devices, or products used to prevent unwanted pregnancy[.], regardless of whether they are to be used by the insured or the partner of the insured, and regardless of whether they are to be used for contraception or exclusively for the prevention of sexually transmitted infections. [(f) Nothing in this section shall be construed to extend the practice or privileges of any health care provider beyond that provided in the laws governing the provider's practice and privileges.]" SECTION 7. Section 431:10A-116.7, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: "(g) For purposes of this section: "Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy. "Contraceptive supplies" means all United States Food and Drug Administration-approved contraceptive drugs [or], devices, or products used to prevent unwanted pregnancy[.], regardless of whether they are to be used by the insured or the partner of the insured, and regardless of whether they are to be used for contraception or exclusively for the prevention of sexually transmitted infections." SECTION 8. Section 432:1-604.5, Hawaii Revised Statutes, is amended to read as follows: "§432:1-604.5 Contraceptive services. (a) Notwithstanding any provision of law to the contrary, each employer group [health policy, contract, plan, or agreement] hospital or medical service plan contract issued or renewed in this State on or after January 1, [2000,] 2024, 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[. (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.] ; 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 otherwise provided by this section, a mutual benefit society shall not impose any restrictions or delays on the coverage required by this section. (c) 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) 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. (e) 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. (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. (g) For purposes of this section: "Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy. "Contraceptive supplies" means all Food and Drug Administration-approved contraceptive drugs or devices used to prevent unwanted pregnancy[. (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.], 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." 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 2024, 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, 2024, 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, 2024. 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 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 made it increasingly difficult for insurers to cover abortion care and assembled a Supreme Court that overturned the right to abortion access and that may eliminate the Patient Protection and Affordable Care Act in the near future.
5252
5353 The legislature further finds that a host of the 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 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) Except as otherwise authorized under this section, an insurer shall not impose any restrictions or delays on the coverage required under this section.
112112
113113 (c) This section shall not require a policy of accident and health or sickness insurance to cover:
114114
115115 (1) Experimental or investigational treatments;
116116
117117 (2) Clinical trials or demonstration projects;
118118
119119 (3) Treatments that do not conform to acceptable and customary standards of medical practice; or
120120
121121 (4) Treatments for which there is insufficient data to determine efficacy.
122122
123123 (d) 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 if:
124124
125125 (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
126126
127127 (2) An in-network provider is unable or unwilling to provide the service, drug, device, product, or procedure in a timely manner.
128128
129129 (e) 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 2024 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2024.
130130
131131 (f) 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.
132132
133133 (g) 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.
134134
135135 (h) A bill or statement for services from any health care provider or insurer shall be sent directly to the person receiving the services.
136136
137137 (i) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6.
138138
139139 §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.
140140
141141 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
142142
143143 (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."
144144
145145 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:
146146
147147 "§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:
148148
149149 (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;
150150
151151 (2) Counseling for sexually transmitted infections, including human immunodeficiency virus and acquired immune deficiency syndrome;
152152
153153 (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;
154154
155155 (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;
156156
157157 (5) Screening and appropriate counseling or interventions for:
158158
159159 (A) Substance abuse, including tobacco and electronic smoking devices, and alcohol; and
160160
161161 (B) Domestic and interpersonal violence;
162162
163163 (6) Screening and appropriate counseling or interventions for mental health screening and counseling, including depression;
164164
165165 (7) Folic acid supplements;
166166
167167 (8) Abortion;
168168
169169 (9) Breastfeeding comprehensive support, counseling, and supplies;
170170
171171 (10) Breast cancer chemoprevention counseling;
172172
173173 (11) Any contraceptive supplies, as specified in section 431:l0A-116.6;
174174
175175 (12) Voluntary sterilization, as a single claim or combined with the following other claims for covered services provided on the same day:
176176
177177 (A) Patient education and counseling on contraception and sterilization; and
178178
179179 (B) Services related to sterilization or the administration and monitoring of contraceptive supplies, including:
180180
181181 (i) Management of side effects;
182182
183183 (ii) Counseling for continued adherence to a prescribed regimen;
184184
185185 (iii) Device insertion and removal; and
186186
187187 (iv) Provision of alternative contraceptive supplies deemed medically appropriate in the judgment of the insured's dependent's health care provider;
188188
189189 (13) Pre-exposure prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination; and
190190
191191 (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.
192192
193193 (b) Except as otherwise authorized under this section, an insurer shall not impose any restrictions or delays on the coverage required under this section.
194194
195195 (c) This section shall not require a policy of accident and health or sickness insurance to cover:
196196
197197 (1) Experimental or investigational treatments;
198198
199199 (2) Clinical trials or demonstration projects;
200200
201201 (3) Treatments that do not conform to acceptable and customary standards of medical practice; or
202202
203203 (4) Treatments for which there is insufficient data to determine efficacy.
204204
205205 (d) 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 if:
206206
207207 (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
208208
209209 (2) An in-network provider is unable or unwilling to provide the service, drug, device, product, or procedure in a timely manner.
210210
211211 (e) 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 2024 when annual information is made available to subscribers or in any other mailing to subscribers, but in no case later than December 31, 2024.
212212
213213 (f) 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.
214214
215215 (g) 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.
216216
217217 (h) A bill or statement for services from any health care provider or insurer shall be sent directly to the person receiving the services.
218218
219219 (i) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6.
220220
221221 §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.
222222
223223 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
224224
225225 (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."
226226
227227 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:
228228
229229 "§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:
230230
231231 (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;
232232
233233 (2) Counseling for sexually transmitted infections, including human immunodeficiency virus and acquired immune deficiency syndrome;
234234
235235 (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;
236236
237237 (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;
238238
239239 (5) Screening and appropriate counseling or interventions for:
240240
241241 (A) Substance abuse, including tobacco and electronic smoking devices, and alcohol; and
242242
243243 (B) Domestic and interpersonal violence;
244244
245245 (6) Screening and appropriate counseling or interventions for mental health screening and counseling, including depression;
246246
247247 (7) Folic acid supplements;
248248
249249 (8) Abortion;
250250
251251 (9) Breastfeeding comprehensive support, counseling, and supplies;
252252
253253 (10) Breast cancer chemoprevention counseling;
254254
255255 (11) Any contraceptive supplies, as specified in section 431:l0A-116.6;
256256
257257 (12) Voluntary sterilization, as a single claim or combined with the following other claims for covered services provided on the same day:
258258
259259 (A) Patient education and counseling on contraception and sterilization; and
260260
261261 (B) Services related to sterilization or the administration and monitoring of contraceptive supplies, including:
262262
263263 (i) Management of side effects;
264264
265265 (ii) Counseling for continued adherence to a prescribed regimen;
266266
267267 (iii) Device insertion and removal; and
268268
269269 (iv) Provision of alternative contraceptive supplies deemed medically appropriate in the judgment of the subscriber's or member's health care provider;
270270
271271 (13) Pre-exposure prophylaxis, post-exposure prophylaxis, and human papillomavirus vaccination; and
272272
273273 (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.
274274
275275 (b) 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.
276276
277277 (c) This section shall not require an individual or group hospital or medical service plan contract to cover:
278278
279279 (1) Experimental or investigational treatments;
280280
281281 (2) Clinical trials or demonstration projects;
282282
283283 (3) Treatments that do not conform to acceptable and customary standards of medical practice; or
284284
285285 (4) Treatments for which there is insufficient data to determine efficacy.
286286
287287 (d) 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 if:
288288
289289 (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
290290
291291 (2) An in-network provider is unable or unwilling to provide the service, drug, device, product, or procedure in a timely manner.
292292
293293 (e) 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 2024 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, 2024.
294294
295295 (f) 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.
296296
297297 (g) 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.
298298
299299 (h) 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.
300300
301301 (i) For purposes of this section, "contraceptive supplies" shall have the same meaning as in section 431:l0A-116.6.
302302
303303 §432:1-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.
304304
305305 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
306306
307307 (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."
308308
309309 SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
310310
311311 "§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.
312312
313313 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
314314
315315 (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."
316316
317317 SECTION 6. Section 431:10A-116.6, Hawaii Revised Statutes, is amended to read as follows:
318318
319319 "§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,] 2024, 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[.
320320
321321 (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.
322322
323323 (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:
324324
325325 (1) Use of brands covered has resulted in an adverse drug reaction; or
326326
327327 (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.]
328328
329329 ; provided that:
330330
331331 (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;
332332
333333 (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;
334334
335335 (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
336336
337337 (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.
338338
339339 (b) Except as otherwise provided by this section, an insurer shall not impose any restrictions or delays on the coverage required by this section.
340340
341341 (c) 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:
342342
343343 (1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
344344
345345 (2) Contraception that is necessary to preserve the life or health of an insured.
346346
347347 (d) 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.
348348
349349 (e) 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.
350350
351351 (f) 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.
352352
353353 (g) For purposes of this section:
354354
355355 "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.
356356
357357 "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.
358358
359359 [(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.]"
360360
361361 SECTION 7. Section 431:10A-116.7, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:
362362
363363 "(g) For purposes of this section:
364364
365365 "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.
366366
367367 "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."
368368
369369 SECTION 8. Section 432:1-604.5, Hawaii Revised Statutes, is amended to read as follows:
370370
371371 "§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,] 2024, 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[.
372372
373373 (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.
374374
375375 (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:
376376
377377 (1) Use of brands covered has resulted in an adverse drug reaction; or
378378
379379 (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.]
380380
381381 ; provided that:
382382
383383 (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;
384384
385385 (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;
386386
387387 (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
388388
389389 (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.
390390
391391 (b) 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.
392392
393393 (c) 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:
394394
395395 (1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
396396
397397 (2) Contraception that is necessary to preserve the life or health of a subscriber or member.
398398
399399 (d) 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.
400400
401401 (e) 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.
402402
403403 (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.
404404
405405 (g) For purposes of this section:
406406
407407 "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.
408408
409409 "Contraceptive supplies" means all Food and Drug Administration-approved contraceptive drugs or devices used to prevent unwanted pregnancy[.
410410
411411 (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.], 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."
412412
413413 SECTION 9. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
414414
415415 "§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."
416416
417417 PART III
418418
419419 SECTION 10. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
420420
421421 "§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.
422422
423423 (b) Violation of this section shall be considered a violation pursuant to chapter 489.
424424
425425 (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."
426426
427427 PART IV
428428
429429 SECTION 11. No later than twenty days prior the convening of the regular session of 2024, 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.
430430
431431 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.
432432
433433 SECTION 13. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
434434
435435 SECTION 14. This Act shall take effect on January 1, 2024, 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, 2024.
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439439 INTRODUCED BY: _____________________________
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441441 INTRODUCED BY:
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443443 _____________________________
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449449 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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455455 Report Title:
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457457 Health Care; Insurance
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461461 Description:
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463463 Requires health insurance coverage for various sexual and reproductive health care services.
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471471 The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.