REPORT TITLE:
Annual Mammograms


DESCRIPTION:
Requires health insurance coverage for low-dose mammograms
annually for women forty years of age and older, or upon
recommendation of a physician for women of any age with a history
of breast cancer.  (SD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        818
THE SENATE                              S.B. NO.           S.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 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 purpose of this Act is to revise the frequency of
 
17 mammogram screening for health insurance purposes.
 
18      SECTION 2.  Section 431:10A-116, Hawaii Revised Statutes, is
 
19 amended to read as follows:
 

 
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 1      "431:10A-116  Coverage for specific services.  Every person
 
 2 insured under a policy of accident and sickness insurance
 
 3 delivered or issued for delivery in this State shall be entitled
 
 4 to the reimbursements and coverages specified below:
 
 5      (1)  Notwithstanding any provision to the contrary, whenever
 
 6           a policy, contract, plan, or agreement provides for
 
 7           reimbursement for any visual or optometric service
 
 8           which is within the lawful scope of practice of a duly
 
 9           licensed optometrist, the person entitled to benefits
 
10           or the person performing the services shall be entitled
 
11           to reimbursement whether the service is performed by a
 
12           licensed physician or by a licensed optometrist.
 
13           Visual or optometric services shall include eye or
 
14           visual examination, or both, or a correction of any
 
15           visual or muscular anomaly, and the supplying of
 
16           opthalmic materials, lenses, contact lenses,
 
17           spectacles, eyeglasses, and appurtenances thereto.
 
18      (2)  Notwithstanding any provision to the contrary, for all
 
19           policies, contracts, plans, or agreements issued on or
 
20           after May 30, 1974, whenever provision is made for
 
21           reimbursement or indemnity for any service related to
 
22           surgical or emergency procedures which is within the
 
23           lawful scope of practice of any practitioner licensed
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1           to practice medicine in this State, reimbursement or
 
 2           indemnification under such policy, contract, plan, or
 
 3           agreement shall not be denied when such services are
 
 4           performed by a dentist acting within the lawful scope
 
 5           of the dentist's license.
 
 6      (3)  Notwithstanding any provision to the contrary, whenever
 
 7           the policy provides reimbursement or payment for any
 
 8           service which is within the lawful scope of practice of
 
 9           a psychologist licensed in this State, the person
 
10           entitled to benefits or performing the service shall be
 
11           entitled to reimbursement or payment, whether the
 
12           service is performed by a licensed physician or
 
13           licensed psychologist.
 
14      (4)  Notwithstanding any provision to the contrary, each
 
15           policy, contract, plan, or agreement issued on or after
 
16           February 1, 1991, except for policies which only
 
17           provide coverage for specified diseases or other
 
18           limited benefit coverage, but including policies issued
 
19           by companies subject to chapter 431, article 10A, part
 
20           II and chapter 432, article 1 shall provide coverage
 
21           for screening by low-dose mammography for occult breast
 
22           cancer as follows:
 
23           [(A) For women thirty-five to thirty-nine years of age,
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1                one baseline mammogram;
 
 2           (B)] (A)  For women forty [to forty-nine years of age,
 
 3                a mammogram every two years;
 
 4           (C)  For women fifty] years of age and older, an annual
 
 5                mammogram; and
 
 6          [(D)] (B)  For a woman of any age with a history of
 
 7                breast cancer or whose mother or sister has had a
 
 8                history of breast cancer, a mammogram upon the
 
 9                recommendation of the woman's physician.
 
10                The services provided in this paragraph are
 
11           subject to any coinsurance provisions which may be in
 
12           force in these policies, contracts, plans, or
 
13           agreements.  [The commissioner shall annually review
 
14           the age and frequency guidelines for mammographic
 
15           screening recommended by the American Cancer Society,
 
16           and shall accordingly adjust the age and frequency
 
17           requirements under subparagraphs (A) to (C) by rule, if
 
18           necessary.]
 
19                For the purpose of this paragraph, the term "low-
 
20           dose mammography" means the x-ray examination of the
 
21           breast using equipment dedicated specifically for
 
22           mammography, including but not limited to the x-ray
 
23           tube, filter, compression device, screens, films, and
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1           cassettes, with an average radiation exposure delivery
 
 2           of less than one rad mid-breast, with two views for
 
 3           each breast.  An insurer may provide the services
 
 4           required by this paragraph through contracts with
 
 5           providers; provided that the contract is determined to
 
 6           be a cost-effective means of delivering the services
 
 7           without sacrifice of quality and meets the approval of
 
 8           the director of health.
 
 9      (5)  (A)  (i)  Notwithstanding any provision to the
 
10                     contrary, whenever a policy, contract, plan,
 
11                     or agreement provides coverage for the
 
12                     children of the insured, that coverage shall
 
13                     also extend to the date of birth of any
 
14                     newborn child to be adopted by the insured;
 
15                     provided that the insured gives written
 
16                     notice to the insurer of the insured's
 
17                     intent to adopt the child prior to the
 
18                     child's date of birth or within thirty days
 
19                     after the child's birth or within the time
 
20                     period required for enrollment of a natural
 
21                     born child under the policy, contract plan,
 
22                     or agreement of the insured, whichever period
 
23                     is longer; provided, however, if the adoption
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1                     proceedings are not successful, the insured
 
 2                     shall reimburse the insurer for any expenses
 
 3                     paid for the child.
 
 4               (ii)  Where notification has not been received by
 
 5                     the insurer prior to the child's birth or
 
 6                     within the specified period following the
 
 7                     child's birth, insurance coverage shall be
 
 8                     effective from the first day following the
 
 9                     insurer's receipt of legal notification of
 
10                     the insured's ability to consent for
 
11                     treatment of the infant for whom coverage is
 
12                     sought.
 
13           (B)  When the insured is a member of a health
 
14                maintenance organization (HMO), coverage of an
 
15                adopted newborn is effective:
 
16                (i)  From the date of birth of the adopted newborn
 
17                     when the newborn is treated from birth
 
18                     pursuant to a provider contract with the
 
19                     health maintenance organization, and written
 
20                     notice of enrollment in accord with the
 
21                     health maintenance organization's usual
 
22                     enrollment process is provided within thirty
 
23                     days of the date the insured notifies the
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1                     health maintenance organization of the
 
 2                     insured's intent to adopt the infant for whom
 
 3                     coverage is sought; or
 
 4               (ii)  From the first day following receipt by the
 
 5                     health maintenance organization of written
 
 6                     notice of the insured's ability to consent
 
 7                     for treatment of the infant for whom coverage
 
 8                     is sought and enrollment of the adopted
 
 9                     newborn in accord with the health maintenance
 
10                     organization's usual enrollment process if
 
11                     the newborn has been treated from birth by a
 
12                     provider not contracting or affiliated with
 
13                     the health maintenance organization."
 
14      SECTION 3.  Section 432:1-605, Hawaii Revised Statutes, is
 
15 amended by amending subsections (a) and (b) to read as follows:
 
16      "(a)  Notwithstanding any provision to the contrary, each
 
17 policy, contract, plan, or agreement issued on or after
 
18 February 1, 1991, except for policies which only provide coverage
 
19 for specified diseases or other limited benefit coverage, but
 
20 including policies issued by companies subject to chapter 431,
 
21 article 10A, part II and chapter 432, article 1 shall provide
 
22 coverage for screening by low-dose mammography for occult breast
 
23 cancer as follows:
 

 
Page 8                                                     818
                                     S.B. NO.           S.D. 2
                                                        
                                                        

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