REPORT TITLE:
Annual Mammograms


DESCRIPTION:
Changes coverage for biennial mammograms for women aged 40 to 49
to annual mammograms for all women aged 40 and older.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
HOUSE OF REPRESENTATIVES                H.B. NO.622        
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE.



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

 1      SECTION 1.  Section 23-51, Hawaii Revised Statutes, requires
 
 2 the auditor to conduct an impact assessment report before any
 
 3 legislative measure that mandates health insurance coverage for
 
 4 specific health services, specific diseases, or certain providers
 
 5 of health care services as part of individual or group health
 
 6 insurance policies can be considered.  However, the legislature
 
 7 finds that this assessment is not necessary under this Act
 
 8 because no new health coverage is being mandated, but rather,
 
 9 only the frequency of mammogram screening for women aged forty to
 
10 forty-nine is being increased from once every two years to once
 
11 every year.  In fact, provisions already exist under sections
 
12 431:10A-116(4) and 432:1-605, Hawaii Revised Statutes, requiring
 
13 the insurance commissioner to annually review and adjust, if
 
14 necessary, by rule, the age and frequency requirements for
 
15 mammographic screening under these two sections.
 
16      The legislature further finds that the addition of the
 
17 mammogram screening requirement for health maintenance
 
18 organizations in section 2 of this Act does not trigger the
 

 
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 1 auditor's assessment because the social and financial impact
 
 2 assessment for mammogram screening for the entire State had
 
 3 already been conducted before the Health Maintenance Organization
 
 4 Act was formally enacted in 1995.  The addition of section 2 of
 
 5 this Act, then, can be more appropriately viewed as a conforming
 
 6 measure to bring health maintenance organizations under the
 
 7 existing coverage requirements for mammogram screening in the
 
 8 State.
 
 9      SECTION 2.  Chapter 432D, Hawaii Revised Statutes, is
 
10 amended by adding a new section to be appropriately designated
 
11 and to read as follows:
 
12      "432D-     Mammogram screening.  (a)  Any other law to the
 
13 contrary notwithstanding, each health maintenance organization
 
14 that provides health coverage to its enrollees in this State
 
15 after December 31, 1999, shall provide coverage for screening by
 
16 low-dose mammography for occult breast cancer as follows:
 
17      (1)  For women thirty-five to thirty-nine years of age, one
 
18           baseline mammogram;
 
19      (2)  For women forty years of age and older, an annual
 
20           mammogram; and
 
21      (3)  For a woman of any age with a history of breast cancer
 
22           or whose mother or sister has had a history of breast
 

 
 
 
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 1           cancer, a mammogram upon the recommendation of the
 
 2           woman's physician.
 
 3      (b)  The services provided in subsection (a) are subject to
 
 4 any coinsurance provisions which may be in force in any health
 
 5 maintenance organization plan.  The commissioner shall annually
 
 6 review the age and frequency guidelines for mammogram screening
 
 7 recommended by the American Cancer Society, and shall accordingly
 
 8 adjust the age and frequency requirements under subsection (a)(1)
 
 9 and (2) by rule, if necessary."
 
10      SECTION 3.  Section 431:10A-116, Hawaii Revised Statutes, is
 
11 amended to read as follows:
 
12      "431:10A-116  Coverage for specific services.  Every person
 
13 insured under a policy of accident and sickness insurance
 
14 delivered or issued for delivery in this State shall be entitled
 
15 to the reimbursements and coverages specified below:
 
16      (1)  Notwithstanding any provision to the contrary, whenever
 
17           a policy, contract, plan, or agreement provides for
 
18           reimbursement for any visual or optometric service
 
19           which is within the lawful scope of practice of a duly
 
20           licensed optometrist, the person entitled to benefits
 
21           or the person performing the services shall be entitled
 
22           to reimbursement whether the service is performed by a
 

 
 
 
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 1           licensed physician or by a licensed optometrist.
 
 2           Visual or optometric services shall include eye or
 
 3           visual examination, or both, or a correction of any
 
 4           visual or muscular anomaly, and the supplying of
 
 5           opthalmic materials, lenses, contact lenses,
 
 6           spectacles, eyeglasses, and appurtenances thereto.
 
 7      (2)  Notwithstanding any provision to the contrary, for all
 
 8           policies, contracts, plans, or agreements issued on or
 
 9           after May 30, 1974, whenever provision is made for
 
10           reimbursement or indemnity for any service related to
 
11           surgical or emergency procedures which is within the
 
12           lawful scope of practice of any practitioner licensed
 
13           to practice medicine in this State, reimbursement or
 
14           indemnification under such policy, contract, plan, or
 
15           agreement shall not be denied when such services are
 
16           performed by a dentist acting within the lawful scope
 
17           of the dentist's license.
 
18      (3)  Notwithstanding any provision to the contrary, whenever
 
19           the policy provides reimbursement or payment for any
 
20           service which is within the lawful scope of practice of
 
21           a psychologist licensed in this State, the person
 
22           entitled to benefits or performing the service shall be
 

 
 
 
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 1           entitled to reimbursement or payment, whether the
 
 2           service is performed by a licensed physician or
 
 3           licensed psychologist.
 
 4      (4)  Notwithstanding any provision to the contrary, each
 
 5           policy, contract, plan, or agreement issued on or after
 
 6           February 1, 1991, except for policies which only
 
 7           provide coverage for specified diseases or other
 
 8           limited benefit coverage, but including policies issued
 
 9           by companies subject to chapter 431, article 10A, part
 
10           II and chapter 432, article 1 shall provide coverage
 
11           for screening by low-dose mammography for occult breast
 
12           cancer as follows:
 
13           (A)  For women thirty-five to thirty-nine years of age,
 
14                one baseline mammogram;
 
15           (B)  For women forty [to forty-nine years of age, a
 
16                mammogram every two years;
 
17           (C)  For women fifty] years of age and older, an annual
 
18                mammogram; and
 
19          [(D)] (C)  For a woman of any age with a history of
 
20                breast cancer or whose mother or sister has had a
 
21                history of breast cancer, a mammogram upon the
 
22                recommendation of the woman's physician.
 

 
 
 
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 1                The services provided in this paragraph are
 
 2           subject to any coinsurance provisions which may be in
 
 3           force in these policies, contracts, plans, or
 
 4           agreements.  The commissioner shall annually review the
 
 5           age and frequency guidelines for mammographic screening
 
 6           recommended by the American Cancer Society, and shall
 
 7           accordingly adjust the age and frequency requirements
 
 8           under subparagraphs (A) [to (C)] and (B) by rule, if
 
 9           necessary.
 
10                For the purpose of this paragraph, the term "low-
 
11           dose mammography" means the x-ray examination of the
 
12           breast using equipment dedicated specifically for
 
13           mammography, including but not limited to the x-ray
 
14           tube, filter, compression device, screens, films, and
 
15           cassettes, with an average radiation exposure delivery
 
16           of less than one rad mid-breast, with two views for
 
17           each breast.  An insurer may provide the services
 
18           required by this paragraph through contracts with
 
19           providers; provided that the contract is determined to
 
20           be a cost-effective means of delivering the services
 
21           without sacrifice of quality and meets the approval of
 
22           the director of health.
 

 
 
 
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 1      (5)  (A)  (i)  Notwithstanding any provision to the
 
 2                     contrary, whenever a policy, contract, plan,
 
 3                     or agreement provides coverage for the
 
 4                     children of the insured, that coverage shall
 
 5                     also extend to the date of birth of any
 
 6                     newborn child to be adopted by the insured;
 
 7                     provided that the insured gives written
 
 8                     notice to the insurer of the insured's
 
 9                     intent to adopt the child prior to the
 
10                     child's date of birth or within thirty days
 
11                     after the child's birth or within the time
 
12                     period required for enrollment of a natural
 
13                     born child under the policy, contract plan,
 
14                     or agreement of the insured, whichever period
 
15                     is longer; provided, however, if the adoption
 
16                     proceedings are not successful, the insured
 
17                     shall reimburse the insurer for any expenses
 
18                     paid for the child.
 
19               (ii)  Where notification has not been received by
 
20                     the insurer prior to the child's birth or
 
21                     within the specified period following the
 
22                     child's birth, insurance coverage shall be
 

 
 
 
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 1                     effective from the first day following the
 
 2                     insurer's receipt of legal notification of
 
 3                     the insured's ability to consent for
 
 4                     treatment of the infant for whom coverage is
 
 5                     sought.
 
 6           (B)  When the insured is a member of a health
 
 7                maintenance organization (HMO), coverage of an
 
 8                adopted newborn is effective:
 
 9                (i)  From the date of birth of the adopted newborn
 
10                     when the newborn is treated from birth
 
11                     pursuant to a provider contract with the
 
12                     health maintenance organization, and written
 
13                     notice of enrollment in accord with the
 
14                     health maintenance organization's usual
 
15                     enrollment process is provided within thirty
 
16                     days of the date the insured notifies the
 
17                     health maintenance organization of the
 
18                     insured's intent to adopt the infant for whom
 
19                     coverage is sought; or
 
20               (ii)  From the first day following receipt by the
 
21                     health maintenance organization of written
 
22                     notice of the insured's ability to consent
 

 
 
 
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 1                     for treatment of the infant for whom coverage
 
 2                     is sought and enrollment of the adopted
 
 3                     newborn in accord with the health maintenance
 
 4                     organization's usual enrollment process if
 
 5                     the newborn has been treated from birth by a
 
 6                     provider not contracting or affiliated with
 
 7                     the health maintenance organization."
 
 8      SECTION 4.  Section 432:1-605, Hawaii Revised Statutes, is
 
 9 amended by amending subsections (a) and (b) to read as follows:
 
10      "(a)  Notwithstanding any provision to the contrary, each
 
11 policy, contract, plan, or agreement issued on or after
 
12 February 1, 1991, except for policies which only provide coverage
 
13 for specified diseases or other limited benefit coverage, but
 
14 including policies issued by companies subject to chapter 431,
 
15 article 10A, part II and chapter 432, article 1 shall provide
 
16 coverage for screening by low-dose mammography for occult breast
 
17 cancer as follows:
 
18      (1)  For women thirty-five to thirty-nine years of age, one
 
19           baseline mammogram;
 
20      (2)  For women forty [to forty-nine years of age, a
 
21           mammogram every two years;
 
22      (3)  For women fifty] years of age and older, an annual
 

 
 
 
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 1           mammogram; and
 
 2 [(4)](3)  For a woman of any age with a history of breast cancer
 
 3           or whose mother or sister has had a history of breast
 
 4           cancer, a mammogram upon the recommendation of the
 
 5           woman's physician.
 
 6      (b)  The services provided in subsection (a) are subject to
 
 7 any coinsurance provisions which may be in force in these
 
 8 policies, contracts, plans, or agreements.  The commissioner
 
 9 shall annually review the age and frequency guidelines for
 
10 mammogram screening recommended by the American Cancer Society,
 
11 and shall accordingly adjust the age and frequency requirements
 
12 under [subsections] subsection (a)(1) [to (3)] and (2) by rule,
 
13 if necessary."
 
14      SECTION 5.  Statutory material to be repealed is bracketed.
 
15 New statutory material is underscored.
 
16      SECTION 6.  This Act shall take effect upon its approval.
 
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18                              INTRODUCED BY:______________________
 
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