STAND. COM. REP. NO. 585
RE: S.B. No. 1326
Honorable Ronald D. Kouchi
President of the Senate
Thirty-Second State Legislature
Regular Session of 2023
State of Hawaii
Your Committee on Commerce and Consumer Protection, to which was referred S.B. No. 1326 entitled:
"A BILL FOR AN ACT RELATING TO TITLE 24, HAWAII REVISED STATUTES,"
begs leave to report as follows:
The purpose and intent of this measure is to:
(1) Provide amendments to external review procedures to improve consistency with the National Association of Insurance Commissioners Uniform Health Carrier External Review Model Act; and
(2) Require health insurers, mutual benefit societies, and health maintenance organizations to cover mandated services for mammography at least as favorably as coverage for other radiological examinations.
Your Committee received testimony in support of this measure from the Department of Commerce and Consumer Affairs and Hawai‘i Women Lawyers.
Your Committee finds that the State's external review process for health plans, codified in chapter 432E, Hawaii Revised Statutes, Part IV, is based largely on the National Association of Insurance Commissioners Uniform Health Carrier External Review Model Act (Model Act). However, state law and the Model Act differ significantly with respect to external review, or situations where an insured seeks an independent review of a health insurer's decision to refuse to pay for or authorize a treatment or service. Existing law compels the Insurance Commissioner to follow a procedure that requires rendering a determination as to whether an enrollee is eligible for external review, regardless of whether there is sufficient information or whether the determination is complicated by issues outside the Insurance Commissioner's jurisdiction. This measure will align state law with the Model Act, which provides the Insurance Commissioner with permissive authority to send a case to external review if the Commissioner determines that the case is eligible. This measure also clarifies that health plans must provide any documents they have received related to an external review request to the independent review organization assigned to conduct an external review.
Your Committee also finds that mammograms are effective in detecting breast cancer at an early stage, which is when treatment is most likely to be successful. However, there are many barriers that prevent women from seeking and obtaining routine screening. Without favorable coverage under insurance plans, women are often faced with having to choose between having to pay for what is generally seen as an "elective procedure" and other important expenses, like rent or buying food for their families. Accordingly, this measure requires that insurers, mutual benefit societies, and health maintenance organizations cover mandated services for mammography at least as favorably as coverage for other radiological examinations.
Your Committee has amended this measure by:
(1) Inserting an effective date of July 1, 2050, to encourage further discussion; and
(2) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.
As affirmed by the record of votes of the members of your Committee on Commerce and Consumer Protection that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1326, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1326, S.D. 1, and be referred to your Committee on Ways and Means.
Respectfully submitted on behalf of the members of the Committee on Commerce and Consumer Protection,
JARRETT KEOHOKALOLE, Chair