REPORT TITLE:
Patient Rights


DESCRIPTION:
Implements patient rights and responsibilities task force
recommendations to the patient bill of rights and
responsibilities act and related laws.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
HOUSE OF REPRESENTATIVES                H.B. NO.1664       
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  In 1998, the legislature passed the Hawaii
 
 2 Patient Bill of Rights and Responsibilities Act, Act 178, Session
 
 3 Laws of Hawaii 1998.  Under Act 178, the Patient Rights and
 
 4 Responsibilities Task Force was convened to, among other things,
 
 5 review Act 178 and determine whether consumer rights are fully
 
 6 protected and whether any further action is needed to ensure such
 
 7 protection.  The purpose of this Act represents the task force's
 
 8 recommendations for statutory revisions that ensure the
 
 9 protection of consumer rights.
 
10      SECTION 2.  Chapter 432E, Hawaii Revised Statutes, is
 
11 amended by adding four new sections to be appropriately
 
12 designated and to read as follows:
 
13      "432E-    Annual report.  The commission shall prepare and
 
14 submit to the legislature on an annual basis a report which shall
 
15 contain the number of external review hearing cases reviewed, the
 
16 type of cases reviewed, a summary of the nature of the cases
 
17 reviewed, and the disposition of the cases reviewed.  The
 
18 identities of the plan and the enrollee shall be protected from
 
19 disclosure in the report.
 

 
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 1      432E-    Health insurance revolving fund.  (a)  There is
 
 2 established a revolving fund in the state treasury to be
 
 3 administered by the commissioner and to be designated as the
 
 4 health insurance revolving fund.
 
 5      (b)  The commissioner may expend moneys from the health
 
 6 insurance revolving fund to hire medical experts who will serve
 
 7 on the review panel or provide an expert medical opinion to the
 
 8 review panel and to conduct a public awareness and education
 
 9 program about managed care plans.
 
10      (c)  Beginning with fiscal year 1999-2000 and each fiscal
 
11 year thereafter, each mutual benefit society under article 1 of
 
12 chapter 432, health maintenance organization under chapter 432D,
 
13 and any other entity offering or providing health benefits or
 
14 services under the regulation of the commissioner, except an
 
15 insurer licensed to offer health insurance under article 10A,
 
16 shall deposit with the commissioner by July 1 of each year an
 
17 assessment based on a pro rata basis as imposed by the
 
18 commissioner.  The assessment shall be credited to the health
 
19 insurance revolving fund.
 
20      (d)  Moneys in the health insurance revolving fund shall not
 
21 revert to the general fund.
 
22      (e)  The commissioner shall report annually to the
 
23 legislature before the convening of each regular session as to
 

 
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                                     H.B. NO.1664       
                                                        
                                                        

 
 1 fund administration and expenditures.
 
 2      432E-    Accreditation of managed care plans.  (a)
 
 3 Beginning with calendar year 1999, the commissioner shall
 
 4 contract with one or more certified vendors of the consumer
 
 5 assessment health plan survey to conduct a survey of all managed
 
 6 care plans actively offering managed care plans in this State;
 
 7 provided that the information collected in 1999 shall be kept
 
 8 confidential such that managed care plans are provided an
 
 9 opportunity to learn whether any deficiencies exist or any
 
10 improvements are required; provided further that the results of
 
11 the consumer assessment health plan survey after the first year
 
12 shall be available to the public.
 
13      (b)  The commissioner shall conduct a program that promotes
 
14 public awareness and education about managed care plans such that
 
15 consumers may make better or more informed choices when selecting
 
16 a managed care plan.
 
17      (c)  Beginning in the year 2000, non-accredited plans shall
 
18 submit a plan to the commissioner to achieve national
 
19 accreditation status within five years.  After the first year of
 
20 the five-year plan, each unaccredited plan shall also submit an
 
21 annual progress report to the insurance commissioner on the
 
22 status of gaining national accreditation.  The commissioner shall
 
23 determine which national accreditation organization is
 

 
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                                     H.B. NO.1664       
                                                        
                                                        

 
 1 appropriate for each type plan.
 
 2      (d)  The costs to fund the survey and educational program
 
 3 shall be borne by the insurance division through the health
 
 4 insurance revolving fund established by section 432E-  .  The
 
 5 commissioner shall be permitted to assess each managed care plan
 
 6 for the actual expenses in administering the survey.
 
 7      (e)  Each mutual benefit society under article 1 of chapter
 
 8 432, health maintenance organization under chapter 432D, and any
 
 9 other entity offering or providing health benefits or services
 
10 under the regulation of the commissioner, except an insurer
 
11 licensed to offer health insurance under article 10A of chapter
 
12 431 shall deposit with the commissioner an amount to provide for
 
13 the actual costs of the survey to be determined by the
 
14 commissioner on July 1 of each year, to be credited to the health
 
15 insurance revolving fund.  In addition, each mutual benefit
 
16 society under article 1 of chapter 432, health maintenance
 
17 organization under chapter 432D, and any other entity offering or
 
18 providing health benefits or services under the regulation of the
 
19 commissioner, except an insurer licensed to offer health
 
20 insurance under article 10A of chapter 431, shall pay to the
 
21 commissioner at a time to be determined by the commissioner, a
 
22 one-time deposit in an amount to be determined by the
 
23 commissioner, to be credited to the health insurance revolving
 

 
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                                     H.B. NO.1664       
                                                        
                                                        

 
 1 fund.
 
 2      432-    Rules.  The commissioner shall adopt rules pursuant
 
 3 to chapter 91 necessary for the purposes of this chapter."
 
 4      SECTION 3.  Section 386-1, Hawaii Revised Statutes, is
 
 5 amended by adding three new definitions to be appropriately
 
 6 inserted and to read as follows:
 
 7      ""Emergency medical condition" means a medical condition
 
 8 that manifests itself by acute symptoms of sufficient severity,
 
 9 including severe pain, such that a prudent layperson, who
 
10 possesses an average knowledge of health and medicine, could
 
11 reasonably expect the absence of immediate medical attention to
 
12 result in:
 
13      (1)  Placing the health of the individual or, with respect
 
14           to a pregnant woman, the health of the woman or her
 
15           unborn child, in serious jeopardy;
 
16      (2)  Serious impairment to bodily functions; or
 
17      (3)  Serious dysfunction of any bodily organ or part.
 
18      "Emergency services" means:
 
19      (1)  A medical screening examination, as required by federal
 
20           law, that is within the capability of the emergency
 
21           department of a hospital, including ancillary services
 
22           routinely available to the emergency department, to
 
23           evaluate an emergency medical condition; or
 

 
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                                     H.B. NO.1664       
                                                        
                                                        

 
 1      (2)  Such further medical examination and treatment, as
 
 2           required by federal law, that is within the
 
 3           capabilities of the staff and facilities available at
 
 4           the hospital including any trauma and burn center of
 
 5           the hospital to stabilize an emergency medical
 
 6           condition.
 
 7      "Stabilize" means the provision of medical treatment as may
 
 8 be necessary to assure, within reasonable medical probability,
 
 9 that no material deterioration of an individual's medical
 
10 condition is likely to result from or occur during a transfer to
 
11 another facility, if the medical condition could result in:
 
12      (1)  Placing the health of the individual or, with respect
 
13           to a pregnant woman, the health of the woman or her
 
14           unborn child, in serious jeopardy;
 
15      (2)  Serious impairment to bodily functions; or
 
16      (3)  Serious dysfunction of any bodily organ or part."
 
17      SECTION 4.  Section 431:10C-103, Hawaii Revised Statutes, is
 
18 amended by adding three new definitions to be appropriately
 
19 inserted and to read as follows:
 
20      ""Emergency medical condition" means a medical condition
 
21 that manifests itself by acute symptoms of sufficient severity,
 
22 including severe pain, such that a prudent layperson, who
 
23 possesses an average knowledge of health and medicine, could
 

 
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 1 reasonably expect the absence of immediate medical attention to
 
 2 result in:
 
 3      (1)  Placing the health of the individual or, with respect
 
 4           to a pregnant woman, the health of the woman or her
 
 5           unborn child, in serious jeopardy;
 
 6      (2)  Serious impairment to bodily functions; or
 
 7      (3)  Serious dysfunction of any bodily organ or part.
 
 8      "Emergency services" means:
 
 9      (1)  A medical screening examination, as required by federal
 
10           law, that is within the capability of the emergency
 
11           department of a hospital, including ancillary services
 
12           routinely available to the emergency department, to
 
13           evaluate an emergency medical condition; or
 
14      (2)  Such further medical examination and treatment, as
 
15           required by federal law, that is within the
 
16           capabilities of the staff and facilities available at
 
17           the hospital including any trauma and burn center of
 
18           the hospital to stabilize an emergency medical
 
19           condition.
 
20      "Stabilize" means the provision of medical treatment as may
 
21 be necessary to assure, within reasonable medical probability,
 
22 that no material deterioration of an individual's medical
 
23 condition is likely to result from or occur during a transfer to
 

 
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 1 another facility, if the medical condition could result in:
 
 2      (1)  Placing the health of the individual or, with respect
 
 3           to a pregnant woman, the health of the woman or her
 
 4           unborn child, in serious jeopardy;
 
 5      (2)  Serious impairment to bodily functions; or
 
 6      (3)  Serious dysfunction of any bodily organ or part."
 
 7      SECTION 5.  Section 432E-5, Hawaii Revised Statutes, is
 
 8 amended to read as follows:
 
 9      "[[]432E-5[]]  Complaints and appeals procedure for
 
10 enrollees.(a)  A managed care plan with enrollees in this State
 
11 shall establish and maintain a procedure to provide for the
 
12 resolution of an enrollee's complaints and appeals.
 
13      (b)  The managed care plan at all times shall make available
 
14 its complaints and appeals procedures.  The complaints and
 
15 appeals procedures shall be reasonably understandable to the
 
16 average layperson and shall be provided in languages other than
 
17 English upon request.
 
18      (c)  A plan shall send notice of its final internal
 
19 determination to the enrollee and the enrollee's appointed
 
20 representative, if applicable, and the commissioner.  The notice
 
21 shall include information regarding the enrollee's right to
 
22 request external review, the thirty day deadline for requesting
 
23 the external review, instructions on how to request external
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1 review, and where to submit the request for external review."
 
 2      SECTION 6.  Section 432E-3, Hawaii Revised Statutes, is
 
 3 amended to read as follows:
 
 4      "[[]432E-3[]]  Access to services.  A managed care plan
 
 5 shall demonstrate to the commissioner upon request that its plan:
 
 6      (1)  Makes benefits available and accessible to each
 
 7           enrollee electing the managed care plan in the defined
 
 8           service area with reasonable promptness and in a manner
 
 9           which promotes continuity in the provision of health
 
10           care services;
 
11      (2)  Provides access to sufficient numbers and types of
 
12           providers to ensure that all covered services will be
 
13           accessible without unreasonable delay;
 
14      (3)  When medically necessary, provides health care services
 
15           twenty-four hours a day, seven days a week;
 
16      (4)  Provides a reasonable choice of qualified providers of
 
17           women's health services such as gynecologists,
 
18           obstetricians, certified nurse-midwives, and advanced
 
19           practice nurses to provide preventive and routine
 
20           women's health care services; [and]
 
21      (5)  Provides payment or reimbursement for adequately
 
22           documented emergency services[.] as provided in Act
 
23           246, Session Laws of Hawaii 1998; and
 

 
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 1      (6)  Allows for standing referrals to specialists who are
 
 2           able to provide and coordinate primary and specialty
 
 3           care for an enrollee's life threatening, chronic,
 
 4           degenerative, or disabling disease or condition."
 
 5      SECTION 7.  Section 432E-6, Hawaii Revised Statutes, is
 
 6 amended to read as follows:
 
 7      "[[]432E-6[]]  Appeals to the commissioner.(a)  After
 
 8 exhausting all internal complaint and appeal procedures
 
 9 available, an enrollee, or the enrollee's treating provider or
 
10 appointed representative, may appeal an adverse decision of a
 
11 managed care plan to a three member review panel appointed by the
 
12 commissioner composed of a representative from a health plan not
 
13 involved in the complaint, a provider licensed to practice and
 
14 practicing medicine in Hawaii not involved in the complaint, and
 
15 the commissioner or the commissioner's designee in the following
 
16 manner:
 
17      (1)  The enrollee shall submit a request for review to the
 
18           commissioner within thirty days from the date of the
 
19           final determination by the managed care plan.
 
20      (2)  Upon receipt of the request and upon a showing of good
 
21           cause, the commissioner shall appoint the members of
 
22           the panel and shall conduct a review hearing pursuant
 
23           to chapter 91.  Where the amount in controversy is less
 

 
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 1           than $500, the commissioner may conduct a review
 
 2           hearing without appointing a review panel.
 
 3      (3)  The review hearing shall be conducted as soon as
 
 4           practicable taking into consideration the medical
 
 5           exigencies of the case; provided that the hearing is
 
 6           held no later than sixty days from the date of the
 
 7           request for hearing.
 
 8      (4)  The commissioner may retain an independent medical
 
 9           expert who is trained in the field of medicine most
 
10           appropriately related to the matter under review and
 
11           who shall not be subject to chapters 76 and 77.  The
 
12           independent medical evidence shall be exempt from the
 
13           requirements of chapter 91.
 
14    [(3)]  (5)  After considering the enrollee's complaint, the
 
15           plan's response, and any affidavits filed by the
 
16           parties, the commissioner may dismiss the appeal if it
 
17           is determined that the appeal is frivolous or without
 
18           merit.
 
19      (6)  The review panel shall review the adverse determination
 
20           to determine whether the plan acted reasonably and with
 
21           sound medical judgment.  The review panel shall
 
22           consider the clinical standards of the plan, the
 
23           information provided, the attending physician's
 

 
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 1           recommendations, and generally accepted practice
 
 2           guidelines.
 
 3      (7)  The commissioner, upon a majority vote of the panel,
 
 4           shall issue an order affirming, modifying, or reversing
 
 5           the decision within thirty days of the hearing.
 
 6      (b)  The procedure set forth in this section shall not apply
 
 7 to claims or allegations of health provider malpractice,
 
 8 professional negligence, or other professional fault against
 
 9 participating providers.
 
10      (c)  [The commissioner may adopt rules pursuant to chapter
 
11 91 to carry out the purposes of this section.] The members of the
 
12 review panel shall have immunity from monetary liability relating
 
13 to their duties as members of the review panel.
 
14      (d)  An enrollee may be allowed an award of a reasonable sum
 
15 for attorney's fees and reasonable costs of suit in an action
 
16 brought against a plan."
 
17      SECTION 8.  Section 432E-7, Hawaii Revised Statutes, is
 
18 amended to read as follows:
 
19      "[[]432E-7[]]  Information to enrollees.  (a)  The managed
 
20 care plan shall provide to its enrollees upon enrollment and
 
21 thereafter upon request the following information:
 
22      (1)  A list of participating providers which shall [indicate
 
23           their specialty and whether board certification has
 

 
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 1           been attained;] be updated on a regular basis
 
 2           indicating, at a minimum, their specialty and whether
 
 3           the provider is accepting new patients;
 
 4      (2)  A complete description of benefits, services, and
 
 5           copayments;
 
 6      (3)  A statement on enrollee's rights, responsibilities, and
 
 7           obligations;
 
 8      (4)  An explanation of the referral process, if any;
 
 9      (5)  Where services or benefits may be obtained;
 
10     [(6)  [A statement regarding informed consent;
 
11     (7)]  (6) Information on complaints and appeals procedures;
 
12           and
 
13    [(8)]  (7)  The telephone number of the insurance division
 
14           [and the office of consumer complaints].
 
15 This information shall be provided to prospective enrollees upon
 
16 request.
 
17      (b)  Every managed care plan shall provide to the
 
18 commissioner and its enrollees notice of any material change in
 
19 [the operation of the organization initiated by the plan that
 
20 will affect them directly within thirty days of the material
 
21 change.] participating provider agreements, services, or benefits
 
22 where:
 
23      (1)  The change affects the organization or operation of the
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           managed care plan; and
 
 2      (2)  The change affects enrollee's services or benefits.
 
 3 The managed care plan shall provide notice to enrollees within
 
 4 sixty days of the change in a format that makes the notice clear
 
 5 and conspicuous such that it is readily noticeable by the
 
 6 enrollee.
 
 7      (c)  [For purposes of this section "material change" means a
 
 8 change in participating provider agreements, services, or
 
 9 benefits.] All managed care plans shall provide generic
 
10 participating provider contracts to enrollees, upon request."
 
11      SECTION 9.  Section 432E-10, Hawaii Revised Statutes, is
 
12 amended by amending subsection (a) to read as follows:
 
13      "(a)  It is the policy of this State that all managed care
 
14 plans shall adopt and comply with nationally developed and
 
15 promulgated standards for measuring quality, outcomes, access,
 
16 satisfaction, and utilization of services.  Every contract
 
17 between a managed care plan and a participating provider of
 
18 health care services shall require the participating provider to
 
19 comply with the managed care plan's requests for any information
 
20 necessary for the managed care plan to comply with the
 
21 requirements of this chapter.  [The standard to be applied is the
 
22 Health Employer Data and Information Set (HEDIS) 3.0 data set, as
 
23 amended from time to time.]  The State shall require that:
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      (1)  Consumers, providers, managed care plans, purchasers,
 
 2           and regulators shall be equitably represented in the
 
 3           development of standards; and
 
 4      (2)  Standards shall result in measurement and reporting
 
 5           that is purposeful, valid and scientifically based,
 
 6           applied in a consistent and comparable manner,
 
 7           efficient and cost effective, and designed to minimize
 
 8           redundancy and duplication of effort."
 
 9      SECTION 10.  Act 246, Session Laws of Hawaii 1998, is
 
10 amended by amending sections 1 to 3 to read as follows:
 
11      "SECTION 1.  Chapter 431, Hawaii Revised Statutes, is
 
12 amended by adding a new section to article 10A to be
 
13 appropriately designated and to read as follows:
 
14      "431:10A-   Emergency medical services.(a)  As used in
 
15 this section unless the context otherwise requires:
 
16      "Emergency medical condition" means a medical condition that
 
17 manifests itself by acute symptoms of sufficient severity,
 
18 including severe pain, such that a prudent layperson, who
 
19 possesses an average knowledge of health and medicine, could
 
20 reasonably expect the absence of immediate medical attention to
 
21 result in:
 
22      (1)  Placing the health of the individual (or, with respect
 
23           to a pregnant woman, the health of the woman or her
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           unborn child) in serious jeopardy;
 
 2      (2)  Serious impairment to bodily functions; or
 
 3      (3)  Serious dysfunction of any bodily organ or part.
 
 4      "Emergency services" means:
 
 5      (1)  A medical screening examination (as required by federal
 
 6           law) that is within the capability of the emergency
 
 7           department of a hospital, including ancillary services
 
 8           routinely available to the emergency department, to
 
 9           evaluate an emergency medical condition; or
 
10      (2)  Such further medical examination and treatment (as
 
11           required by federal law) that is within the
 
12           capabilities of the staff and facilities available at
 
13           the hospital (including any trauma and burn center of
 
14           the hospital), to stabilize an emergency medical
 
15           condition.
 
16      "Stabilize" means the provision of medical treatment as may
 
17 be necessary to assure, within reasonable medical probability,
 
18 that no material deterioration of an individual's medical
 
19 condition is likely to result from or occur during a transfer to
 
20 another facility, if the medical condition could result in:
 
21      (1)  Placing the health of the individual (or with respect
 
22           to a pregnant woman, the health of the woman or her
 
23           unborn child) in serious jeopardy;
 

 
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 1      (2)  Serious impairment to bodily functions; or
 
 2      (3)  Serious dysfunction of any bodily organ or part.
 
 3 In the case of a woman having contractions, "stabilize" means
 
 4 medical treatment as may be necessary to deliver (including the
 
 5 placenta).
 
 6      "Stabilized" means that no material deterioration of an
 
 7 individual's medical condition, as described in this subsection,
 
 8 is likely, within reasonable medical probability, to result from
 
 9 or occur during the transfer of the individual from a facility,
 
10 or in the case of a woman having contractions, that the woman has
 
11 delivered (including the placenta).
 
12      (b)  A health plan shall cover emergency services provided
 
13 twenty-four hours a day, seven days a week to members with
 
14 emergency medical conditions without regard to whether the
 
15 member, or an emergency provider treating the member, obtained
 
16 prior authorization for these services.
 
17      (c)  A health plan shall cover emergency services provided
 
18 to a member at a participating emergency department if the member
 
19 presents oneself with an emergency medical condition.
 
20      (d)  A health plan shall cover emergency services provided
 
21 to a member at a nonparticipating emergency department up to the
 
22 point of stabilization if:
 
23      (1)  The member presents oneself with an emergency medical
 

 
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 1           condition; and
 
 2      (2)  One of the following applies:
 
 3           (A)  Due to circumstances beyond the member's control,
 
 4                the member was unable to arrive at a participating
 
 5                emergency department without serious threat to
 
 6                life or health;
 
 7           (B)  A prudent layperson possessing an average
 
 8                knowledge of health and medicine would have
 
 9                reasonably believed that, under the circumstances,
 
10                the time required to go to a participating
 
11                emergency provider or department could result in
 
12                one or more of the following:
 
13                (i)  Placing the health of the individual (or,
 
14                     with respect to a pregnant woman, the health
 
15                     of the woman or her unborn child) in serious
 
16                     jeopardy;
 
17               (ii)  Serious impairment to bodily functions; or
 
18              (iii)  Serious dysfunction of any bodily organ or
 
19                     part; or
 
20           (C)  A person authorized by the health plan refers the
 
21                member to an emergency department and does not
 
22                specify a participating emergency department.
 
23      (e)  Except as provided in subsection (f), a health plan
 

 
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 1 shall not be required to reimburse an emergency provider or an
 
 2 emergency department for any services, other than those medically
 
 3 necessary to stabilize a member, until:
 
 4      (1)  The emergency department has contacted the member's
 
 5           health benefits plan; and
 
 6      (2)  There is agreement between the emergency provider and
 
 7           the plan concerning treatment and services to be
 
 8           provided by the emergency provider after the member is
 
 9           stabilized.
 
10      (f)  A health plan shall select between the following two
 
11 options:
 
12      (1)  A health plan shall reimburse an emergency provider and
 
13           an emergency department for any items or services not
 
14           necessary to stabilize the patient but that are
 
15           determined to be medically necessary to treat the
 
16           illness that [lead] led the patient to believe that he
 
17           or she had an emergency medical condition, and that a
 
18           reasonable patient would expect to receive from a
 
19           physician at the time of presentation[.]; or
 
20      (2)  A health plan shall reimburse an emergency provider and
 
21           an emergency department for any items or services not
 
22           necessary to stabilize the patient but that are
 
23           determined to be medically necessary by the emergency
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1           provider, if the emergency department:
 
 2           (A)  After a documented good faith effort, is unable to
 
 3                reach the enrollee's health plan:
 
 4                (i)  Within thirty minutes from the initial
 
 5                     examination of the enrollee; or
 
 6               (ii)  If the enrollee needs to be stabilized,
 
 7                     within thirty minutes of stabilization; or
 
 8           (B)  Has successfully contacted the plan as required in
 
 9                paragraph (A) above, and has not received a denial
 
10                from the plan within thirty minutes of the initial
 
11                contact, unless the plan is able to document that
 
12                it has made an unsuccessful good faith effort to
 
13                reach the emergency department within thirty
 
14                minutes after receiving the request for
 
15                authorization; or
 
16           (C)  Has successfully contacted the plan and has
 
17                received a denial from a person other than a
 
18                participating physician and:
 
19                (i)  A participating physician authorized by the
 
20                     plan to review denials reverses the denial;
 
21                     or
 
22               (ii)  A participating physician authorized by the
 
23                     plan to review denials fails to communicate a
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1                     determination affirming the denial unless the
 
 2                     treating physician waives the requirement for
 
 3                     such determination, within thirty minutes
 
 4                     after the initial denial is communicated by
 
 5                     the plan; and
 
 6      (3)  A health plan shall immediately arrange for an
 
 7           alternate plan of treatment for the member in the event
 
 8           a non-participating emergency provider and the plan are
 
 9           unable to reach agreement on services necessary beyond
 
10           those immediately needed to stabilize the member, under
 
11           which:
 
12           (A)  A participating physician with privileges at the
 
13                hospital arrives at the emergency department of
 
14                the hospital promptly and assumes responsibility
 
15                for the treatment of the member; or
 
16           (B)  With the agreement of the treating physician or
 
17                another health professional in the emergency
 
18                department:
 
19                (i)  Arrangement is made for transfer of the
 
20                     member to another facility using medical
 
21                     resources consistent with the condition of
 
22                     the enrollee;
 
23               (ii)  An appointment is made with a participating
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1                     physician or provider for treatment needed by
 
 2                     the enrollee; or
 
 3              (iii)  Another arrangement is made for treatment of
 
 4                     the enrollee.
 
 5      (g)  A health plan that arranges for, or otherwise covers,
 
 6 urgent care services and comprehensive primary care may impose
 
 7 different cost-sharing on the member for:
 
 8      (1)  Use of an emergency department over another setting;
 
 9           and
 
10      (2)  Use of a nonparticipating emergency department over a
 
11           participating emergency department unless:
 
12           (A)  Due to circumstances beyond the member's control,
 
13                the member was unable to arrive at a participating
 
14                emergency department without serious threat to
 
15                life or health; or
 
16           (B)  A prudent layperson possessing an average
 
17                knowledge of health and medicine would have
 
18                reasonably believed that, under the circumstances,
 
19                the time required to go to a participating
 
20                emergency department could result in one or more
 
21                of the following:
 
22                (i)  Placing the health of the individual (or,
 
23                     with respect to a pregnant woman, the health
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1                     of the woman or her unborn child) in serious
 
 2                     jeopardy;
 
 3               (ii)  Serious impairment to bodily functions; or
 
 4              (iii)  Serious dysfunction of any bodily organ or
 
 5                     part.
 
 6      (h)  A health plan that provides coverage for emergency
 
 7 medical services shall educate members on:
 
 8      (1)  Coverage for emergency medical services;
 
 9      (2)  The appropriate use of emergency services, including
 
10           the use of the 911 system and other telephone access
 
11           systems used to access prehospital emergency services;
 
12      (3)  Any cost sharing provisions for emergency services; and
 
13      (4)  The procedures for obtaining emergency and other
 
14           medical services so that members are familiar with the
 
15           location of in-plan emergency departments and with the
 
16           location and availability of other in-plan settings at
 
17           which they could receive medical care.
 
18      SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended
 
19 by adding a new section to article 1 to be appropriately
 
20 designated and to read as follows:
 
21      "432:1-   Emergency medical services.(a)  As used in
 
22 this section unless the context otherwise requires:
 
23      "Emergency medical condition" means a medical condition that
 

 
Page 24                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1 manifests itself by acute symptoms of sufficient severity,
 
 2 including severe pain, such that a prudent layperson, who
 
 3 possesses an average knowledge of health and medicine, could
 
 4 reasonably expect the absence of immediate medical attention to
 
 5 result in:
 
 6      (1)  Placing the health of the individual (or, with respect
 
 7           to a pregnant woman, the health of the woman or her
 
 8           unborn child) in serious jeopardy;
 
 9      (2)  Serious impairment to bodily functions; or
 
10      (3)  Serious dysfunction of any bodily organ or part.
 
11      "Emergency services" means:
 
12      (1)  A medical screening examination (as required by federal
 
13           law) that is within the capability of the emergency
 
14           department of a hospital, including ancillary services
 
15           routinely available to the emergency department, to
 
16           evaluate an emergency medical condition; or
 
17      (2)  Such further medical examination and treatment (as
 
18           required by federal law) that is within the
 
19           capabilities of the staff and facilities available at
 
20           the hospital (including any trauma and burn center of
 
21           the hospital), to stabilize an emergency medical
 
22           condition.
 
23      "Stabilize" means the provision of medical treatment as may
 

 
Page 25                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1 be necessary to assure, within reasonable medical probability,
 
 2 that no material deterioration of an individual's medical
 
 3 condition is likely to result from or occur during a transfer to
 
 4 another facility, if the medical condition could result in:
 
 5      (1)  Placing the health of the individual (or with respect
 
 6           to a pregnant woman, the health of the woman or her
 
 7           unborn child) in serious jeopardy;
 
 8      (2)  Serious impairment to bodily functions; or
 
 9      (3)  Serious dysfunction of any bodily organ or part.
 
10 In the case of a woman having contractions, "stabilize" means
 
11 medical treatment as may be necessary to deliver (including the
 
12 placenta).
 
13      "Stabilized" means that no material deterioration of an
 
14 individual's medical condition, as described in this subsection,
 
15 is likely, within reasonable medical probability, to result from
 
16 or occur during the transfer of the individual from a facility,
 
17 or in the case of a woman having contractions, that the woman has
 
18 delivered (including the placenta).
 
19      (b)  A health plan shall cover emergency services provided
 
20 twenty-four hours a day, seven days a week to members with
 
21 emergency medical conditions without regard to whether the
 
22 member, or an emergency provider treating the member, obtained
 
23 prior authorization for these services.
 

 
Page 26                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1      (c)  A health plan shall cover emergency services provided
 
 2 to a member at a participating emergency department if the member
 
 3 presents oneself with an emergency medical condition.
 
 4      (d)  A health plan shall cover emergency services provided
 
 5 to a member at a nonparticipating emergency department up to the
 
 6 point of stabilization if:
 
 7      (1)  The member presents oneself with an emergency medical
 
 8           condition; and
 
 9      (2)  One of the following applies:
 
10           (A)  Due to circumstances beyond the member's control,
 
11                the member was unable to arrive at a participating
 
12                emergency department without serious threat to
 
13                life or health;
 
14           (B)  A prudent layperson possessing an average
 
15                knowledge of health and medicine would have
 
16                reasonably believed that, under the circumstances,
 
17                the time required to go to a participating
 
18                emergency provider or department could result in
 
19                one or more of the following:
 
20                (i)  Placing the health of the individual (or,
 
21                     with respect to a pregnant woman, the health
 
22                     of the woman or her unborn child) in serious
 
23                     jeopardy;
 

 
Page 27                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1               (ii)  Serious impairment to bodily functions; or
 
 2              (iii)  Serious dysfunction of any bodily organ or
 
 3                     part; or
 
 4           (C)  A person authorized by the health plan refers the
 
 5                member to an emergency department and does not
 
 6                specify a participating emergency department.
 
 7      (e)  Except as provided in subsection (f), a health plan
 
 8 shall not be required to reimburse an emergency provider or an
 
 9 emergency department for any services, other than those medically
 
10 necessary to stabilize a member, until:
 
11      (1)  The emergency department has contacted the member's
 
12           health benefits plan; and
 
13      (2)  There is agreement between the emergency provider and
 
14           the plan concerning treatment and services to be
 
15           provided by the emergency provider after the member is
 
16           stabilized.
 
17      (f)  A health plan shall select between the following two
 
18 options:
 
19           (1)  A health plan shall reimburse an emergency
 
20                provider and an emergency department for any items
 
21                or services not necessary to stabilize the patient
 
22                but that are determined to be medically necessary
 
23                to treat the illness that [lead] led the patient
 

 
Page 28                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1                to believe that he or she had an emergency medical
 
 2                condition, and that a reasonable patient would
 
 3                expect to receive from a physician at the time of
 
 4                presentation[.]; or
 
 5           (2)  A health plan shall reimburse an emergency
 
 6                provider and an emergency department for any items
 
 7                or services not necessary to stabilize the patient
 
 8                but that are determined to be medically necessary
 
 9                by the emergency provider, if the emergency
 
10                department:
 
11                (A)  After a documented good faith effort, is
 
12                     unable to reach the enrollee's health plan:
 
13                     (i)  Within thirty minutes from the initial
 
14                          examination of the enrollee; or
 
15                    (ii)  If the enrollee needs to be stabilized,
 
16                          within thirty minutes of stabilization;
 
17                          or
 
18                (B)  Has successfully contacted the plan as
 
19                     required in paragraph (A) above, and has not
 
20                     received a denial from the plan within thirty
 
21                     minutes of the initial contact, unless the
 
22                     plan is able to document that it has made an
 
23                     unsuccessful good faith effort to reach the
 

 
Page 29                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1                     emergency department within thirty minutes
 
 2                     after receiving the request for
 
 3                     authorization; or
 
 4                (C)  Has successfully contacted the plan and has
 
 5                     received a denial from a person other than a
 
 6                     participating physician and:
 
 7                     (i)  A participating physician authorized by
 
 8                          the plan to review denials reverses the
 
 9                          denial; or
 
10                    (ii)  A participating physician authorized by
 
11                          the plan to review denials fails to
 
12                          communicate a determination affirming
 
13                          the denial unless the treating physician
 
14                          waives the requirement for such
 
15                          determination, within thirty minutes
 
16                          after the initial denial is communicated
 
17                          by the plan; and
 
18           (3)  A health plan shall immediately arrange for an
 
19                alternate plan of treatment for the member in the
 
20                event a non-participating emergency provider and
 
21                the plan are unable to reach agreement on services
 
22                necessary beyond those immediately needed to
 
23                stabilize the member, under which:
 

 
Page 30                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1                (A)  A participating physician with privileges at
 
 2                     the hospital arrives at the emergency
 
 3                     department of the hospital promptly and
 
 4                     assumes responsibility for the treatment of
 
 5                     the member; or
 
 6                (B)  With the agreement of the treating physician
 
 7                     or another health professional in the
 
 8                     emergency department:
 
 9                     (i)  Arrangement is made for transfer of the
 
10                          member to another facility using medical
 
11                          resources consistent with the condition
 
12                          of the enrollee;
 
13                    (ii)  An appointment is made with a
 
14                          participating physician or provider for
 
15                          treatment needed by the enrollee; or
 
16                   (iii)  Another arrangement is made for
 
17                          treatment of the enrollee.
 
18      (g)  A health plan that arranges for, or otherwise covers,
 
19 urgent care services and comprehensive primary care may impose
 
20 different cost-sharing on the member for:
 
21      (1)  Use of an emergency department over another setting;
 
22           and
 
23      (2)  Use of a nonparticipating emergency department over a
 

 
Page 31                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1           participating emergency department unless:
 
 2           (A)  Due to circumstances beyond the member's control,
 
 3                the member was unable to arrive at a participating
 
 4                emergency department without serious threat to
 
 5                life or health; or
 
 6           (B)  A prudent layperson possessing an average
 
 7                knowledge of health and medicine would have
 
 8                reasonably believed that, under the circumstances,
 
 9                the time required to go to a participating
 
10                emergency department could result in one or more
 
11                of the following:
 
12                (i)  Placing the health of the individual (or,
 
13                     with respect to a pregnant woman, the health
 
14                     of the woman or her unborn child) in serious
 
15                     jeopardy;
 
16               (ii)  Serious impairment to bodily functions; or
 
17              (iii)  Serious dysfunction of any bodily organ or
 
18                     part.
 
19      (h)  A health plan that provides coverage for emergency
 
20 medical services shall educate members on:
 
21      (1)  Coverage for emergency medical services;
 
22      (2)  The appropriate use of emergency services, including
 
23           the use of the 911 system and other telephone access
 

 
Page 32                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1           systems used to access prehospital emergency services;
 
 2      (3)  Any cost sharing provisions for emergency services; and
 
 3      (4)  The procedures for obtaining emergency and other
 
 4           medical services so that members are familiar with the
 
 5           location of in-plan emergency departments and with the
 
 6           location and availability of other in-plan settings at
 
 7           which they could receive medical care.
 
 8      SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is
 
 9 amended by adding a new section to be appropriately designated
 
10 and to read as follows:
 
11      "432D-   Emergency medical services.(a)  As used in
 
12 this section unless the context otherwise requires:
 
13      "Emergency medical condition" means a medical condition that
 
14 manifests itself by acute symptoms of sufficient severity,
 
15 including severe pain, such that a prudent layperson, who
 
16 possesses an average knowledge of health and medicine, could
 
17 reasonably expect the absence of immediate medical attention to
 
18 result in:
 
19      (1)  Placing the health of the individual (or, with respect
 
20           to a pregnant woman, the health of the woman or her
 
21           unborn child) in serious jeopardy;
 
22      (2)  Serious impairment to bodily functions; or
 
23      (3)  Serious dysfunction of any bodily organ or part.
 

 
Page 33                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1      "Emergency services" means:
 
 2      (1)  A medical screening examination (as required by federal
 
 3           law) that is within the capability of the emergency
 
 4           department of a hospital, including ancillary services
 
 5           routinely available to the emergency department, to
 
 6           evaluate an emergency medical condition; or
 
 7      (2)  Such further medical examination and treatment (as
 
 8           required by federal law) that is within the
 
 9           capabilities of the staff and facilities available at
 
10           the hospital (including any trauma and burn center of
 
11           the hospital), to stabilize an emergency medical
 
12           condition.
 
13      "Stabilize" means the provision of medical treatment as may
 
14 be necessary to assure, within reasonable medical probability,
 
15 that no material deterioration of an individual's medical
 
16 condition is likely to result from or occur during a transfer to
 
17 another facility, if the medical condition could result in:
 
18      (1)  Placing the health of the individual (or with respect
 
19           to a pregnant woman, the health of the woman or her
 
20           unborn child) in serious jeopardy;
 
21      (2)  Serious impairment to bodily functions; or
 
22      (3)  Serious dysfunction of any bodily organ or part.
 
23 In the case of a woman having contractions, "stabilize" means
 

 
Page 34                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1 medical treatment as may be necessary to deliver (including the
 
 2 placenta).
 
 3      "Stabilized" means that no material deterioration of an
 
 4 individual's medical condition, as described in this subsection,
 
 5 is likely, within reasonable medical probability, to result from
 
 6 or occur during the transfer of the individual from a facility,
 
 7 or in the case of a woman having contractions, that the woman has
 
 8 delivered (including the placenta).
 
 9      (b)  A health plan shall cover emergency services provided
 
10 twenty-four hours a day, seven days a week to members with
 
11 emergency medical conditions without regard to whether the
 
12 member, or an emergency provider treating the member, obtained
 
13 prior authorization for these services.
 
14      (c)  A health plan shall cover emergency services provided
 
15 to a member at a participating emergency department if the member
 
16 presents oneself with an emergency medical condition.
 
17      (d)  A health plan shall cover emergency services provided
 
18 to a member at a nonparticipating emergency department up to the
 
19 point of stabilization if:
 
20      (1)  The member presents oneself with an emergency medical
 
21           condition; and
 
22      (2)  One of the following applies:
 
23           (A)  Due to circumstances beyond the member's control,
 

 
Page 35                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1                the member was unable to arrive at a participating
 
 2                emergency department without serious threat to
 
 3                life or health;
 
 4           (B)  A prudent layperson possessing an average
 
 5                knowledge of health and medicine would have
 
 6                reasonably believed that, under the circumstances,
 
 7                the time required to go to a participating
 
 8                emergency provider or department could result in
 
 9                one or more of the following:
 
10                (i)  Placing the health of the individual (or,
 
11                     with respect to a pregnant woman, the health
 
12                     of the woman or her unborn child) in serious
 
13                     jeopardy;
 
14               (ii)  Serious impairment to bodily functions; or
 
15              (iii)  Serious dysfunction of any bodily organ or
 
16                     part;
 
17                or
 
18           (C)  A person authorized by the health plan refers the
 
19                member to an emergency department and does not
 
20                specify a participating emergency department.
 
21      (e)  Except as provided in subsection (f), a health plan
 
22 shall not be required to reimburse an emergency provider or an
 
23 emergency department for any services, other than those medically
 

 
Page 36                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1 necessary to stabilize a member, until:
 
 2      (1)  The emergency department has contacted the member's
 
 3           health benefits plan; and
 
 4      (2)  There is agreement between the emergency provider and
 
 5           the plan concerning treatment and services to be
 
 6           provided by the emergency provider after the member is
 
 7           stabilized.
 
 8      (f)  A health plan shall select between the following two
 
 9 options:
 
10      (1)  A health plan shall reimburse an emergency provider and
 
11           an emergency department for any items or services not
 
12           necessary to stabilize the patient but that are
 
13           determined to be medically necessary to treat the
 
14           illness that [lead] led the patient to believe that he
 
15           or she had an emergency medical condition, and that a
 
16           reasonable patient would expect to receive from a
 
17           physician at the time of presentation[.]; or
 
18      (2)  A health plan shall reimburse an emergency provider and
 
19           an emergency department for any items or services not
 
20           necessary to stabilize the patient but that are
 
21           determined to be medically necessary by the emergency
 
22           provider, if the emergency department:
 
23 ]         (A)  After a documented good faith effort, is unable to
 

 
Page 37                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1                reach the enrollee's health plan:
 
 2                (i)  Within thirty minutes from the initial
 
 3                     examination of the enrollee; or
 
 4               (ii)  If the enrollee needs to be stabilized,
 
 5                     within thirty minutes of stabilization; or
 
 6           (B)  Has successfully contacted the plan as required in
 
 7                paragraph (A) above, and has not received a denial
 
 8                from the plan within thirty minutes of the initial
 
 9                contact, unless the plan is able to document that
 
10                it has made an unsuccessful good faith effort to
 
11                reach the emergency department within thirty
 
12                minutes after receiving the request for
 
13                authorization; or
 
14           (C)  Has successfully contacted the plan and has
 
15                received a denial from a person other than a
 
16                participating physician and:
 
17                (i)  A participating physician authorized by the
 
18                     plan to review denials reverses the denial;
 
19                     or
 
20               (ii)  A participating physician authorized by the
 
21                     plan to review denials fails to communicate a
 
22                     determination affirming the denial unless the
 
23                     treating physician waives the requirement for
 

 
Page 38                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1                     such determination, within thirty minutes
 
 2                     after the initial denial is communicated by
 
 3                     the plan; and
 
 4      (3)  A health plan shall immediately arrange for an
 
 5           alternate plan of treatment for the member in the event
 
 6           a non-participating emergency provider and the plan are
 
 7           unable to reach agreement on services necessary beyond
 
 8           those immediately needed to stabilize the member, under
 
 9           which:
 
10           (A)  A participating physician with privileges at the
 
11                hospital arrives at the emergency department of
 
12                the hospital promptly and assumes responsibility
 
13                for the treatment of the member; or
 
14           (B)  With the agreement of the treating physician or
 
15                another health professional in the emergency
 
16                department:
 
17                (i)  Arrangement is made for transfer of the
 
18                     member to another facility using medical
 
19                     resources consistent with the condition of
 
20                     the enrollee;
 
21               (ii)  An appointment is made with a participating
 
22                     physician or provider for treatment needed by
 
23                     the enrollee; or
 

 
Page 39                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1              (iii)  Another arrangement is made for treatment of
 
 2                     the enrollee.
 
 3      (g)  A health plan that arranges for, or otherwise covers,
 
 4 urgent care services and comprehensive primary care may impose
 
 5 different cost-sharing on the member for:
 
 6      (1)  Use of an emergency department over another setting;
 
 7           and
 
 8      (2)  Use of a nonparticipating emergency department over a
 
 9           participating emergency department unless:
 
10           (A)  Due to circumstances beyond the member's control,
 
11                the member was unable to arrive at a participating
 
12                emergency department without serious threat to
 
13                life or health; or
 
14           (B)  A prudent layperson possessing an average
 
15                knowledge of health and medicine would have
 
16                reasonably believed that, under the circumstances,
 
17                the time required to go to a participating
 
18                emergency department could result in one or more
 
19                of the following:
 
20                (i)  Placing the health of the individual (or,
 
21                     with respect to a pregnant woman, the health
 
22                     of the woman or her unborn child) in serious
 
23                     jeopardy;
 

 
Page 40                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1               (ii)  Serious impairment to bodily functions; or
 
 2              (iii)  Serious dysfunction of any bodily organ or
 
 3                     part.
 
 4      (i)  A health plan that provides coverage for emergency
 
 5 medical services shall educate members on:
 
 6      (1)  Coverage for emergency medical services;
 
 7      (2)  The appropriate use of emergency services, including
 
 8           the use of the 911 system and other telephone access
 
 9           systems used to access prehospital emergency services;
 
10      (3)  Any cost sharing provisions for emergency services; and
 
11      (4)  The procedures for obtaining emergency and other
 
12           medical services so that members are familiar with the
 
13           location of in-plan emergency departments and with the
 
14           location and availability of other in-plan settings at
 
15           which they could receive medical care."
 
16      SECTION 11.  Upon approval of this Act, each mutual benefit
 
17 society under article 1 of chapter 432, Hawaii Revised Statutes,
 
18 health maintenance organization under chapter 432D, Hawaii
 
19 Revised Statutes, and any other entity offering or providing
 
20 health benefits or services under the regulation of the
 
21 commissioner, except an insurer licensed to offer health
 
22 insurance under article 10A of chapter 431, Hawaii Revised
 
23 Statutes, shall pay to the commissioner at a time determined by
 

 
Page 41                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1 the commissioner, a one-time deposit in an amount not to exceed
 
 2 an aggregate amount of $150,000, to be credited to the health
 
 3 insurance revolving fund.
 
 4      SECTION 12.  There is appropriated out of the health
 
 5 insurance revolving fund the sum of $100,000, or so much thereof
 
 6 as may be necessary for fiscal year 1999-2000, and the same sum,
 
 7 or so much thereof as may be necessary for fiscal year 2000-2001
 
 8 to carry out the purposes of this Act.
 
 9      SECTION 13.  The sums appropriated shall be expended by the
 
10 department of commerce and consumer affairs for the purposes of
 
11 this Act.
 
12      SECTION 14.  There is appropriated out of the health
 
13 insurance revolving fund the sum of $50,000, or so much thereof
 
14 as may be necessary for fiscal year 1999-2000, and the same sum,
 
15 or so much thereof as may be necessary for fiscal year 2000-2001
 
16 to carry out the purposes of this Act.
 
17      SECTION 15.  The sums appropriated shall be expended by the
 
18 department of commerce and consumer affairs for the purposes of
 
19 this Act.
 
20      SECTION 16.  There is appropriated out of the health
 
21 insurance revolving fund the sum of $          , or so much
 
22 thereof as may be necessary for fiscal year 1999-2000, and the
 
23 same sum, or so much thereof as may be necessary for fiscal year
 

 
Page 42                                                    
                                     H.B. NO.           
                                                        
                                                        

 
 1 2000-2001 to carry out the purposes of this Act.
 
 2      SECTION 17.  The sums appropriated shall be expended by the
 
 3 department of commerce and consumer affairs for the purposes of
 
 4 this Act.
 
 5      SECTION 18.  Statutory material to be repealed is bracketed.
 
 6 New statutory material is underscored.
 
 7      SECTION 19.  This Act shall take effect on July 1, l999;
 
 8 provided that sections 3, 4, 6, and 10 of this Act are repealed
 
 9 on July 1, 2003, and that sections 386-1, 431:10C-103, and 432E-
 
10 3, Hawaii Revised Statutes, are reenacted in the form in which
 
11 they read on the day before the effective date of this Act.
 
12 
 
13                           INTRODUCED BY:  _______________________