| 47 | | - | SECTION 1. The purpose of this Act is to reduce incidences of breast cancer and breast cancer-related deaths by mandating insurance coverage for early breast cancer screenings. The legislature notes that the auditor assessed the social and financial impacts of a virtually identical measure (S.B. No. 827, S.D. 2 (2021)) in Report No. 23-03, Study of Proposed Mandatory Health Insurance Coverage for Early Access Breast Cancer Screening, which was issued in February 2023. The legislature believes that the auditor's 2023 assessment of the measure's mandate remains valid for purposes of sections 23-51 and 23-52, Hawaii Revised Statutes, this year. 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 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] 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 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] a patient forty years of age and older, an annual mammogram; and (B) For a [woman] patient of any age [with] having an above‑average risk of developing breast cancer as determined by the use of a risk-factor modeling tool, 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.] any supplemental imaging deemed medically necessary by the patient's primary care provider. The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements; provided that the insured's dollar limits, deductibles, and copayments for services shall be on terms at least as favorable to the insured as those applicable to other radiological examinations. For the [purpose] purposes of this paragraph, [the term] "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. 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) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or before January 1, 2026, except for policies that only provide coverage for specific 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, for a patient of any age, any supplemental imaging deemed medically necessary by the patient's primary care provider, including breast magnetic resonance imaging, ultrasound, or digital breast tomosynthesis. For the purposes of this paragraph, "digital breast tomosynthesis" means a radiologic procedure that involves the acquisition of a projection of images over the stationary breast to produce cross-sectional, digital, three-dimensional images of the breast; and [(5)] (6) (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 to read as follows: "§432:1-605 [Mammogram] Breast cancer screening[.]; mammography. (a) 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: (1) For [women] a patient forty years of age and older, an annual mammogram; and (2) For a [woman] a patient of any age [with] having an above-average risk of developing breast cancer as determined by the use of a risk-factor modeling tool, 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.] any supplemental imaging deemed medically necessary by the patient's primary care provider. (b) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or before January 1, 2026, except for policies that only provides 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, for a patient of any age, any supplemental imaging deemed medically necessary by the patient's primary care provider, including breast magnetic resonance imaging, ultrasound, or digital breast tomosynthesis. [(b)] (c) The services provided in [subsection] subsections (a) and (b) are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements; provided that the member's dollar limits, deductibles, and copayments for services shall be on terms at least as favorable to the member as those applicable to other radiological examinations. [(c)] (d) For the purposes of this section[, "low-dose]: "Digital breast tomosynthesis" means a radiologic procedure that involves the acquisition of a projection of images over the stationary breast to produce cross-sectional, digital, three‑dimensional images 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. [(d)] (e) An insurer may provide the services required by this section 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." SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date. SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 6. This Act shall take effect on December 31, 2050. |
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| 47 | + | SECTION 1. The purpose of this Act is to reduce incidences of breast cancer and breast cancer-related deaths by mandating insurance coverage for early breast cancer screenings. The legislature notes that the auditor assessed the social and financial impacts of a virtually identical measure (Senate Bill No. 827 (2021)) in Report No. 23-03, Study of Proposed Mandatory Health Insurance Coverage for Early Access Breast Cancer Screening, which was issued in February 2023. The legislature believes that the auditor's 2023 assessment of the measure's mandate remains valid for purposes of sections 23-51 and 23-52, Hawaii Revised Statutes, this year. 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 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] 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 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 forty years of age and older, an annual mammogram; and (B) For a woman of any age [with] having an above‑average risk of developing breast cancer as determined by the use of a risk-factor modeling tool, a history of breast cancer, or whose mother or sister has had a history of breast cancer, [a] an annual mammogram [upon the recommendation of the woman's physician]. The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements; provided that the insured's dollar limits, deductibles, and copayments for services shall be on terms at least as favorable to the insured as those applicable to other radiological examinations. For [the purpose] purposes of this paragraph, [the term] "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. 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) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or before January 1, 2026, except for policies that only provide coverage for specific diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article I, shall provide additional breast cancer screening coverage as follows: (A) For women thirty years of age and older, a formal risk factor screening assessment informed by any available risk factor modeling tool; and (B) For a woman of any age, any additional supplemental imaging deemed medically necessary by an applicable American College of Radiology guideline, including breast magnetic resonance imaging, ultrasound, or digital breast tomosynthesis. For purposes of this paragraph, "digital breast tomosynthesis" means a radiologic procedure that involves the acquisition of a projection of images over the stationary breast to produce cross-sectional, digital, three-dimensional images of the breast; and [(5)] (6) (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 to read as follows: "§432:1-605 [Mammogram] Breast cancer screening[.]; mammography. (a) 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: (1) For women forty years of age and older, an annual mammogram; and (2) For a woman of any age [with] having an above-average risk of developing breast cancer as determined by the use of a risk-factor modeling tool, a history of breast cancer, or whose mother or sister has had a history of breast cancer, [a] an annual mammogram [upon the recommendation of the woman's physician]. (b) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or before January 1, 2026, 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 additional breast cancer screening coverage as follows: (1) For women thirty years of age and older, a formal risk factor screening assessment informed by any available risk factor modeling tool; and (2) For a woman of any age, any additional supplemental imaging deemed medically necessary by an applicable American College of Radiology guideline, including breast magnetic resonance imaging, ultrasound, or digital breast tomosynthesis. [(b)] (c) The services provided in [subsection] subsections (a) and (b) are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements; provided that the member's dollar limits, deductibles, and copayments for services shall be on terms at least as favorable to the member as those applicable to other radiological examinations. [(c)] (d) For purposes of this section[, "low-dose]: "Digital breast tomosynthesis" means a radiologic procedure that involves the acquisition of a projection of images over the stationary breast to produce cross-sectional, digital, three‑dimensional images 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. [(d)] (e) An insurer may provide the services required by this section 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." SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date. SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 6. This Act shall take effect on July 1, 2025. INTRODUCED BY: _____________________________ |
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