REPORT TITLE:
Adv. Practice Reg. Nurses


DESCRIPTION:
Requires coverage and equitable reimbursement for advanced
practice registered nurses in all health insurance policies,
contracts, plans and agreements. Includes advance practice
registered nurses in the definition of medical care, services, or
supplies under the Workers' Compensation law.  (HB743 CD1)

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        743
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 3
TWENTIETH LEGISLATURE, 1999                                S.D. 1
STATE OF HAWAII                                            C.D. 1
                                                        
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO ADVANCED PRACTICE REGISTERED NURSES.



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

 1      SECTION 1.  Chapter 432, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to article I to be appropriately
 
 3 designated and to read as follows:
 
 4      "�432:1-     Coverage and reimbursement for services of
 
 5 advanced practice registered nurses.  All individual and group
 
 6 hospital and medical service plan contracts and medical service
 
 7 corporation contracts under this article shall provide
 
 8 reimbursement for health plan-covered services provided by
 
 9 advanced practice registered nurses recognized pursuant to
 
10 chapter 457."
 
11      SECTION 2.  Section 386-1, Hawaii Revised Statutes, is
 
12 amended by amending the definitions of "medical care", "medical
 
13 services", or "medical supplies", to read as follows:
 
14      ""Medical care", "medical services", or "medical
 
15 supplies"[,] means every type of care, treatment, surgery,
 
16 hospitalization, attendance, service, and supplies as the nature
 
17 of the work injury requires, and includes such care, services,
 
18 and supplies rendered or furnished by a licensed or certified
 
19 physician, dispensing optician, physical therapist, nurse,
 
20 advanced practice registered nurse as recognized pursuant to
 

 

Page 2                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
                                                        C.D. 1
                                                        

 1 chapter 457, or masseur."
 
 2      SECTION 3.  Section 431:10A-116, Hawaii Revised Statutes, is
 
 3 amended to read as follows:
 
 4      "�431:10A-116  Coverage for specific services.  Every person
 
 5 insured under a policy of accident and sickness insurance
 
 6 delivered or issued for delivery in this State shall be entitled
 
 7 to the reimbursements and coverages specified below:
 
 8      (1)  Notwithstanding any provision to the contrary, whenever
 
 9           a policy, contract, plan, or agreement provides for
 
10           reimbursement for any visual or optometric service
 
11           which is within the lawful scope of practice of a duly
 
12           licensed optometrist, the person entitled to benefits
 
13           or the person performing the services shall be entitled
 
14           to reimbursement whether the service is performed by a
 
15           licensed physician or by a licensed optometrist.
 
16           Visual or optometric services shall include eye or
 
17           visual examination, or both, or a correction of any
 
18           visual or muscular anomaly, and the supplying of
 
19           opthalmic materials, lenses, contact lenses,
 
20           spectacles, eyeglasses, and appurtenances thereto[.];
 
21      (2)  Notwithstanding any provision to the contrary, for all
 
22           policies, contracts, plans, or agreements issued on or
 
23           after May 30, 1974, whenever provision is made for
 

 

Page 3                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
                                                        C.D. 1
                                                        

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

 

Page 4                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
                                                        C.D. 1
                                                        

 1           for screening by low-dose mammography for occult breast
 
 2           cancer as follows:
 
 3           (A)  For women thirty-five to thirty-nine years of age,
 
 4                one baseline mammogram;
 
 5           (B)  For women forty to forty-nine years of age, a
 
 6                mammogram every two years;
 
 7           (C)  For women fifty years of age and older, an annual
 
 8                mammogram; and
 
 9           (D)  For a woman of any age with a history of breast
 
10                cancer or whose mother or sister has had a history
 
11                of breast cancer, a mammogram upon the
 
12                recommendation of the woman's physician.
 
13                The services provided in this paragraph are
 
14           subject to any coinsurance provisions which may be in
 
15           force in these policies, contracts, plans, or
 
16           agreements.  The commissioner shall annually review the
 
17           age and frequency guidelines for mammographic screening
 
18           recommended by the American Cancer Society, and shall
 
19           accordingly adjust the age and frequency requirements
 
20           under subparagraphs (A) to (C) by rule, if necessary.
 
21                For the purpose of this paragraph, the term "low-
 
22           dose mammography" means the x-ray examination of the
 
23           breast using equipment dedicated specifically for
 

 

Page 5                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
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 1           mammography, including but not limited to the x-ray
 
 2           tube, filter, compression device, screens, films, and
 
 3           cassettes, with an average radiation exposure delivery
 
 4           of less than one rad mid-breast, with two views for
 
 5           each breast.  An insurer may provide the services
 
 6           required by this paragraph through contracts with
 
 7           providers; provided that the contract is determined to
 
 8           be a cost-effective means of delivering the services
 
 9           without sacrifice of quality and meets the approval of
 
10           the director of health[.];
 
11      (5)  (A)  (i)  Notwithstanding any provision to the
 
12                     contrary, whenever a policy, contract, plan,
 
13                     or agreement provides coverage for the
 
14                     children of the insured, that coverage shall
 
15                     also extend to the date of birth of any
 
16                     newborn child to be adopted by the insured;
 
17                     provided that the insured gives written
 
18                     notice to the insurer of the insured's
 
19                     intent to adopt the child prior to the
 
20                     child's date of birth or within thirty days
 
21                     after the child's birth or within the time
 
22                     period required for enrollment of a natural
 
23                     born child under the policy, contract plan,
 

 

Page 6                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
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 1                     or agreement of the insured, whichever period
 
 2                     is longer; provided, however, if the adoption
 
 3                     proceedings are not successful, the insured
 
 4                     shall reimburse the insurer for any expenses
 
 5                     paid for the child[.]; and
 
 6               (ii)  Where notification has not been received by
 
 7                     the insurer prior to the child's birth or
 
 8                     within the specified period following the
 
 9                     child's birth, insurance coverage shall be
 
10                     effective from the first day following the
 
11                     insurer's receipt of legal notification of
 
12                     the insured's ability to consent for
 
13                     treatment of the infant for whom coverage is
 
14                     sought[.];
 
15                and
 
16           (B)  When the insured is a member of a health
 
17                maintenance organization (HMO), coverage of an
 
18                adopted newborn is effective:
 
19                (i)  From the date of birth of the adopted newborn
 
20                     when the newborn is treated from birth
 
21                     pursuant to a provider contract with the
 
22                     health maintenance organization, and written
 
23                     notice of enrollment in accord with the
 

 

Page 7                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
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 1                     health maintenance organization's usual
 
 2                     enrollment process is provided within thirty
 
 3                     days of the date the insured notifies the
 
 4                     health maintenance organization of the
 
 5                     insured's intent to adopt the infant for whom
 
 6                     coverage is sought; or
 
 7               (ii)  From the first day following receipt by the
 
 8                     health maintenance organization of written
 
 9                     notice of the insured's ability to consent
 
10                     for treatment of the infant for whom coverage
 
11                     is sought and enrollment of the adopted
 
12                     newborn in accord with the health maintenance
 
13                     organization's usual enrollment process if
 
14                     the newborn has been treated from birth by a
 
15                     provider not contracting or affiliated with
 
16                     the health maintenance organization[.];
 
17           and
 
18      (6)  Notwithstanding any provision to the contrary, any
 
19           policy, contract, plan, or agreement issued or renewed
 
20           in this State shall provide reimbursement for services
 
21           provided by advanced practice registered nurses
 
22           recognized pursuant to chapter 457.  Services rendered
 
23           by advanced practice registered nurses are subject to
 

 

Page 8                                                     743
                                     H.B. NO.           H.D. 3
                                                        S.D. 1
                                                        C.D. 1
                                                        

 1           the same policy limitations generally applicable to
 
 2           health care providers within the policy, contract,
 
 3           plan, or agreement."
 
 4      SECTION 4.  Section 431:10C-103.5, Hawaii Revised Statutes,
 
 5 is amended by amending subsection (a) to read as follows:
 
 6      "(a)  Personal injury protection benefits, with respect to
 
 7 any accidental harm, means all appropriate and reasonable
 
 8 treatment and expenses necessarily incurred as a result of the
 
 9 accidental harm and which are substantially comparable to the
 
10 requirements for prepaid health care plans, including medical,
 
11 hospital, surgical, professional, nursing, advanced practice
 
12 nursing recognized pursuant to chapter 457, dental, optometric,
 
13 chiropractic, ambulance, prosthetic services, products and
 
14 accommodations furnished, x-ray, psychiatric, physical therapy
 
15 pursuant to prescription by a medical doctor, occupational
 
16 therapy, rehabilitation, and therapeutic massage by a licensed
 
17 massage therapist when prescribed by a medical doctor."
 
18      SECTION 5.  Statutory material to be repealed is bracketed.
 
19 New statutory material is underscored.
 
20      SECTION 6.  This Act shall take effect upon its approval.