REPORT TITLE:
Annual Mammograms


DESCRIPTION:
Provides health insurance coverage of mammograms:  (1) annually
for women aged 40 and older; or (2) earlier if recommended by a
physician.
(HB622 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        622
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
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
 
 3 considering any legislative measure that "mandates health
 
 4 insurance coverage for specific health services" or "diseases" as
 
 5 part of individual or group health insurance policies.  The
 
 6 legislature finds that under this Act this assessment is not
 
 7 necessary because no new health service is being mandated, and no
 
 8 new disease is being covered.  Rather, only the frequency of
 
 9 existing coverage for mammogram screening for women aged forty
 
10 and over is being increased from once every two years to once
 
11 every year.
 
12      SECTION 2.  Section 431:10A-116, Hawaii Revised Statutes, is
 
13 amended to read as follows:
 
14      "431:10A-116  Coverage for specific services.  Every person
 
15 insured under a policy of accident and sickness insurance
 
16 delivered or issued for delivery in this State shall be entitled
 
17 to the reimbursements and coverages specified below:
 
18      (1)  Notwithstanding any provision to the contrary, whenever
 
19           a policy, contract, plan, or agreement provides for
 
20           reimbursement for any visual or optometric service,
 

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1                history of breast cancer, a mammogram upon the
 
 2                recommendation of the woman's physician.
 
 3                The services provided in this paragraph are
 
 4           subject to any coinsurance provisions [which] that may
 
 5           be in force in these policies, contracts, plans, or
 
 6           agreements.  [The commissioner shall annually review
 
 7           the age and frequency guidelines for mammographic
 
 8           screening recommended by the American Cancer Society,
 
 9           and shall accordingly adjust the age and frequency
 
10           requirements under subparagraphs (A) to (C) by rule, if
 
11           necessary.]
 
12                For the purpose of this paragraph, the term "low-
 
13           dose mammography" means the x-ray examination of the
 
14           breast using equipment dedicated specifically for
 
15           mammography, including but not limited to the x-ray
 
16           tube, filter, compression device, screens, films, and
 
17           cassettes, with an average radiation exposure delivery
 
18           of less than one rad mid-breast, with two views for
 
19           each breast.  An insurer may provide the services
 
20           required by this paragraph through contracts with
 
21           providers; provided that the contract is determined to
 
22           be a cost-effective means of delivering the services
 

 
 
 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1           without sacrifice of quality and meets the approval of
 
 2           the director of health[.];
 
 3      (5)  (A)  (i)  Notwithstanding any provision to the
 
 4                     contrary, whenever a policy, contract, plan,
 
 5                     or agreement provides coverage for the
 
 6                     children of the insured, that coverage shall
 
 7                     also extend to the date of birth of any
 
 8                     newborn child to be adopted by the insured;
 
 9                     provided that the insured gives written
 
10                     notice to the insurer of the insured's
 
11                     intent to adopt the child prior to the
 
12                     child's date of birth or within thirty days
 
13                     after the child's birth or within the time
 
14                     period required for enrollment of a natural
 
15                     born child under the policy, contract plan,
 
16                     or agreement of the insured, whichever period
 
17                     is longer; provided[, however,] further that
 
18                     if the adoption proceedings are not
 
19                     successful, the insured shall reimburse the
 
20                     insurer for any expenses paid for the
 
21                     child[.]; and
 
22               (ii)  Where notification has not been received by
 
23                     the insurer prior to the child's birth or
 
24                     within the specified period following the
 

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 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 3.  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] that only provide
 
13 coverage for specified diseases or other limited benefit
 
14 coverage, but including policies issued by companies subject to
 
15 chapter 431, article 10A, part II and chapter 432, article 1
 
16 shall provide coverage for screening by low-dose mammography for
 
17 occult breast cancer as follows:
 
18      [(1) For women thirty-five to thirty-nine years of age, one
 
19           baseline mammogram;
 
20      (2)] (1)  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
 
23           mammogram; and
 

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

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