Hawaii 2024 Regular Session

Hawaii Senate Bill SB600 Compare Versions

Only one version of the bill is available at this time.

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1	1	THE SENATE S.B. NO. 600 THIRTY-SECOND LEGISLATURE, 2023 STATE OF HAWAII A BILL FOR AN ACT RELATING TO BREAST CANCER SCREENING. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	THE SENATE S.B. NO. 600
4	4	THIRTY-SECOND LEGISLATURE, 2023
5	5	STATE OF HAWAII
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7	7	THE SENATE
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9	9	S.B. NO.
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11	11	600
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13	13	THIRTY-SECOND LEGISLATURE, 2023
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	RELATING TO BREAST CANCER SCREENING.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature is committed to ensuring that all women have ready access to breast cancer screening, regardless of age and ethnicity, provided that these screenings are requested by state licensed and authorized medical practitioners. The legislature has serious reservations about the implementation of United States preventive services task force guidelines with respect to breast cancer screening. In 2009 and 2016, the United States preventive services task force released recommendations that were a significant departure from screening guidelines issued by leading clinical organizations, including the American College of Radiology, the National Comprehensive Cancer Network, and the American Medical Association. If the United States preventive services task force guidelines were implemented, insurance plans would no longer be required to cover annual mammography without cost sharing for millions of women forty to forty-nine years of age. The legislature recognizes that the federal government has delayed implementation of United States preventive services task force guidelines through legislatively enacted moratoriums, the most recent of which is scheduled to expire January 1, 2025. The legislature finds that there is ample data showing that annual mammographic screenings significantly reduce breast cancer deaths and morbidity and that effective screening programs are in the best interest of the State and its residents. The legislature further recognizes that certain ethnic groups suffer a disproportionately higher rate of breast cancer diagnoses before the age of fifty. The legislature is concerned that minority women would also be disproportionately and adversely impacted by United States preventive services task force guidelines limiting their access to life saving screening. The purpose of this Act is to improve breast cancer detection rates in the State by: (1) Increasing the categories of women required to be covered for mammogram screenings; (2) Requiring the existing health insurance mandate for coverage of low-dose mammography to include digital mammography and breast tomosynthesis; (3) Defining "digital breast tomosynthesis"; and (4) Requiring health care providers to be reimbursed at rates accurately reflecting the resource costs specific to each service, including any increased resource cost after January 1, 2023. SECTION 2. Section 431:10A-116, Hawaii Revised Statutes, is amended to read as follows: "§431:10A-116 Coverage for specific services. Every person insured under a policy of accident and health or sickness insurance delivered or issued for delivery in this State shall be entitled to the reimbursements and coverages specified below: (1) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any visual or optometric service, [, which] that is within the lawful scope of practice of a duly licensed optometrist, the person entitled to benefits or the person performing the [services] service shall be entitled to reimbursement whether the service is performed by a licensed physician or by a licensed optometrist. Visual or optometric services shall include eye or visual examination, or both, or a correction of any visual or muscular anomaly, and the supplying of ophthalmic materials, lenses, contact lenses, spectacles, eyeglasses, and appurtenances thereto; (2) Notwithstanding any provision to the contrary, for all policies, contracts, plans, or agreements issued on or after May 30, 1974, whenever provision is made for reimbursement or indemnity for any service related to a surgical or emergency [procedures, which] procedure that is within the lawful scope of practice of any practitioner licensed to practice medicine in this State, reimbursement or indemnification under the policy, contract, plan, or agreement shall not be denied when the [services are] service is performed by a dentist acting within the lawful scope of the dentist's license; (3) Notwithstanding any provision to the contrary, whenever the policy provides reimbursement or payment for any service, [, which] that is within the lawful scope of practice of a psychologist licensed in this State, the person entitled to benefits or performing the service shall be entitled to reimbursement or payment, whether the service is performed by a licensed physician or licensed psychologist; (4) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article 1, shall provide coverage for screening by low-dose mammography for occult breast cancer as follows: (A) For women thirty-five years of age through thirty-nine years of age, a baseline mammogram; (B) For women forty years of age and older, an annual mammogram; [and (B)](C) For women thirty years of age or older that are deemed by a licensed physician or clinician to have an above-average risk for breast cancer, an annual mammogram; (D) For [a woman] women of any age [with] having a history of breast cancer or whose mother or sister has had a history of breast cancer, a mammogram upon the recommendation of the woman's physician[.]; and (E) For women of any age, any additional or supplemental imaging, including breast magnetic resonance imaging or ultrasound, deemed medically necessary by an applicable American College of Radiology guideline. The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements[.], and shall be at least as favorable and subject to the same dollar limits, deductibles, and co-payments as other radiological examinations; provided, however, that on and after January 1, 2023, providers of health care services specified under this section shall be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost. For [the purpose] purposes of this paragraph[, the term "low-dose]: "Digital breast tomosynthesis" means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose, two-dimensional projections obtained by different x‑ray tube angles, creating a series of images forming a three-dimensional representation of the breast. "Low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid‑breast, with two views for each breast. "Low-dose mammography" includes digital mammography, digital breast tomosynthesis, and the practice of interpreting and rendering a report by a radiologist or other physician based on the screening. An insurer may provide the services required by this paragraph through contracts with providers; provided that the contract is determined to be a cost‑effective means of delivering the services without sacrifice of quality and meets the approval of the director of health; and (5) (A) (i) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides coverage for the children of the insured, that coverage shall also extend to the date of birth of any newborn child to be adopted by the insured; provided that the insured [gives] shall give written notice to the insurer of the insured's intent to adopt the child prior to the child's date of birth or within thirty days after the child's birth or within the time period required for enrollment of a natural born child under the policy, contract, plan, or agreement of the insured, whichever period is longer; provided further that if the adoption proceedings are not successful, the insured shall reimburse the insurer for any expenses paid for the child; and (ii) Where notification has not been received by the insurer prior to the child's birth or within the specified period following the child's birth, insurance coverage shall be effective from the first day following the insurer's receipt of legal notification of the insured's ability to consent for treatment of the infant for whom coverage is sought; and (B) When the insured is a member of a health maintenance organization, coverage of an adopted newborn is effective: (i) From the date of birth of the adopted newborn when the newborn is treated from birth pursuant to a provider contract with the health maintenance organization, and written notice of enrollment in accord with the health maintenance organization's usual enrollment process is provided within thirty days of the date the insured notifies the health maintenance organization of the insured's intent to adopt the infant for whom coverage is sought; or (ii) From the first day following receipt by the health maintenance organization of written notice of the insured's ability to consent for treatment of the infant for whom coverage is sought and enrollment of the adopted newborn in accord with the health maintenance organization's usual enrollment process if the newborn has been treated from birth by a provider not contracting or affiliated with the health maintenance organization." SECTION 3. Section 432:1-605, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows: "(c) For purposes of this section[, "low-dose]: "Digital breast tomosynthesis" means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose, two-dimensional projections obtained by different x-ray tube angles, creating a series of images forming a three-dimensional representation of the breast. "Low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast. "Low-dose mammography" includes digital mammography, digital breast tomosynthesis, and the practice of interpreting and rendering a report by a radiologist or other physician based on the screening." SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 5. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature is committed to ensuring that all women have ready access to breast cancer screening, regardless of age and ethnicity, provided that these screenings are requested by state licensed and authorized medical practitioners.
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51	51	The legislature has serious reservations about the implementation of United States preventive services task force guidelines with respect to breast cancer screening. In 2009 and 2016, the United States preventive services task force released recommendations that were a significant departure from screening guidelines issued by leading clinical organizations, including the American College of Radiology, the National Comprehensive Cancer Network, and the American Medical Association. If the United States preventive services task force guidelines were implemented, insurance plans would no longer be required to cover annual mammography without cost sharing for millions of women forty to forty-nine years of age.
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53	53	The legislature recognizes that the federal government has delayed implementation of United States preventive services task force guidelines through legislatively enacted moratoriums, the most recent of which is scheduled to expire January 1, 2025.
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55	55	The legislature finds that there is ample data showing that annual mammographic screenings significantly reduce breast cancer deaths and morbidity and that effective screening programs are in the best interest of the State and its residents. The legislature further recognizes that certain ethnic groups suffer a disproportionately higher rate of breast cancer diagnoses before the age of fifty. The legislature is concerned that minority women would also be disproportionately and adversely impacted by United States preventive services task force guidelines limiting their access to life saving screening.
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57	57	The purpose of this Act is to improve breast cancer detection rates in the State by:
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59	59	(1) Increasing the categories of women required to be covered for mammogram screenings;
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61	61	(2) Requiring the existing health insurance mandate for coverage of low-dose mammography to include digital mammography and breast tomosynthesis;
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63	63	(3) Defining "digital breast tomosynthesis"; and
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65	65	(4) Requiring health care providers to be reimbursed at rates accurately reflecting the resource costs specific to each service, including any increased resource cost after January 1, 2023.
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67	67	SECTION 2. Section 431:10A-116, Hawaii Revised Statutes, is amended to read as follows:
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69	69	"§431:10A-116 Coverage for specific services. Every person insured under a policy of accident and health or sickness insurance delivered or issued for delivery in this State shall be entitled to the reimbursements and coverages specified below:
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71	71	(1) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any visual or optometric service, [, which] that is within the lawful scope of practice of a duly licensed optometrist, the person entitled to benefits or the person performing the [services] service shall be entitled to reimbursement whether the service is performed by a licensed physician or by a licensed optometrist. Visual or optometric services shall include eye or visual examination, or both, or a correction of any visual or muscular anomaly, and the supplying of ophthalmic materials, lenses, contact lenses, spectacles, eyeglasses, and appurtenances thereto;
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73	73	(2) Notwithstanding any provision to the contrary, for all policies, contracts, plans, or agreements issued on or after May 30, 1974, whenever provision is made for reimbursement or indemnity for any service related to a surgical or emergency [procedures, which] procedure that is within the lawful scope of practice of any practitioner licensed to practice medicine in this State, reimbursement or indemnification under the policy, contract, plan, or agreement shall not be denied when the [services are] service is performed by a dentist acting within the lawful scope of the dentist's license;
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75	75	(3) Notwithstanding any provision to the contrary, whenever the policy provides reimbursement or payment for any service, [, which] that is within the lawful scope of practice of a psychologist licensed in this State, the person entitled to benefits or performing the service shall be entitled to reimbursement or payment, whether the service is performed by a licensed physician or licensed psychologist;
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77	77	(4) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article 1, shall provide coverage for screening by low-dose mammography for occult breast cancer as follows:
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79	79	(A) For women thirty-five years of age through thirty-nine years of age, a baseline mammogram;
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81	81	(B) For women forty years of age and older, an annual mammogram; [and
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83	83	(B)](C) For women thirty years of age or older that are deemed by a licensed physician or clinician to have an above-average risk for breast cancer, an annual mammogram;
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85	85	(D) For [a woman] women of any age [with] having a history of breast cancer or whose mother or sister has had a history of breast cancer, a mammogram upon the recommendation of the woman's physician[.]; and
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87	87	(E) For women of any age, any additional or supplemental imaging, including breast magnetic resonance imaging or ultrasound, deemed medically necessary by an applicable American College of Radiology guideline.
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89	89	The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements[.], and shall be at least as favorable and subject to the same dollar limits, deductibles, and co-payments as other radiological examinations; provided, however, that on and after January 1, 2023, providers of health care services specified under this section shall be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost.
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91	91	For [the purpose] purposes of this paragraph[, the term "low-dose]:
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93	93	"Digital breast tomosynthesis" means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose, two-dimensional projections obtained by different x‑ray tube angles, creating a series of images forming a three-dimensional representation of the breast.
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95	95	"Low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid‑breast, with two views for each breast. "Low-dose mammography" includes digital mammography, digital breast tomosynthesis, and the practice of interpreting and rendering a report by a radiologist or other physician based on the screening.
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97	97	An insurer may provide the services required by this paragraph through contracts with providers; provided that the contract is determined to be a cost‑effective means of delivering the services without sacrifice of quality and meets the approval of the director of health; and
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99	99	(5) (A) (i) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides coverage for the children of the insured, that coverage shall also extend to the date of birth of any newborn child to be adopted by the insured; provided that the insured [gives] shall give written notice to the insurer of the insured's intent to adopt the child prior to the child's date of birth or within thirty days after the child's birth or within the time period required for enrollment of a natural born child under the policy, contract, plan, or agreement of the insured, whichever period is longer; provided further that if the adoption proceedings are not successful, the insured shall reimburse the insurer for any expenses paid for the child; and
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101	101	(ii) Where notification has not been received by the insurer prior to the child's birth or within the specified period following the child's birth, insurance coverage shall be effective from the first day following the insurer's receipt of legal notification of the insured's ability to consent for treatment of the infant for whom coverage is sought; and
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103	103	(B) When the insured is a member of a health maintenance organization, coverage of an adopted newborn is effective:
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105	105	(i) From the date of birth of the adopted newborn when the newborn is treated from birth pursuant to a provider contract with the health maintenance organization, and written notice of enrollment in accord with the health maintenance organization's usual enrollment process is provided within thirty days of the date the insured notifies the health maintenance organization of the insured's intent to adopt the infant for whom coverage is sought; or
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107	107	(ii) From the first day following receipt by the health maintenance organization of written notice of the insured's ability to consent for treatment of the infant for whom coverage is sought and enrollment of the adopted newborn in accord with the health maintenance organization's usual enrollment process if the newborn has been treated from birth by a provider not contracting or affiliated with the health maintenance organization."
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109	109	SECTION 3. Section 432:1-605, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:
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111	111	"(c) For purposes of this section[, "low-dose]:
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113	113	"Digital breast tomosynthesis" means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose, two-dimensional projections obtained by different x-ray tube angles, creating a series of images forming a three-dimensional representation of the breast.
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115	115	"Low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast. "Low-dose mammography" includes digital mammography, digital breast tomosynthesis, and the practice of interpreting and rendering a report by a radiologist or other physician based on the screening."
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117	117	SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
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119	119	SECTION 5. This Act shall take effect upon its approval.
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123	123	INTRODUCED BY: _____________________________
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125	125	INTRODUCED BY:
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133	133	Report Title: Insurance; Breast Cancer Detection; Covered Service; Digital Mammography; Breast Tomosynthesis Description: Increases the categories of women required to be covered for mammogram screenings. Requires the existing health insurance mandate for coverage of low-dose mammography to include digital mammography and breast tomosynthesis. Defines "digital breast tomosynthesis". Requires health care providers to be reimbursed at rates accurately reflecting the resource costs specific to each service, including any increased resource cost after 1/1/2023. 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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139	139	Report Title:
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141	141	Insurance; Breast Cancer Detection; Covered Service; Digital Mammography; Breast Tomosynthesis
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145	145	Description:
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147	147	Increases the categories of women required to be covered for mammogram screenings. Requires the existing health insurance mandate for coverage of low-dose mammography to include digital mammography and breast tomosynthesis. Defines "digital breast tomosynthesis". Requires health care providers to be reimbursed at rates accurately reflecting the resource costs specific to each service, including any increased resource cost after 1/1/2023.
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155	155	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.