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 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        743
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 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 chapter shall provide reasonable
 
 8 reimbursement for health plan covered services provided by
 
 9 advanced practice registered nurses as recognized in section 457-
 
10 8.5."
 
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, or masseur."
 

 
Page 2                                                     743
                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
Page 3                                                     743
                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
Page 4                                                     743
                                     H.B. NO.           H.D. 2
                                                        
                                                        

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

 
Page 5                                                     743
                                     H.B. NO.           H.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
 

 
Page 6                                                     743
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1                     proceedings are not successful, the insured
 
 2                     shall reimburse the insurer for any expenses
 
 3                     paid for the child[.]; and
 
 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
 

 
Page 7                                                     743
                                     H.B. NO.           H.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           and
 
15      (6)  Notwithstanding any provision to the contrary, any
 
16           policy, contract, plan, or agreement issued or renewed
 
17           in this state shall contain a provision for coverage
 
18           and equitable reimbursement for services of advanced
 
19           practice registered nurses as recognized in section
 
20           457-8.5."
 
21      SECTION 4.  Section 431:10C-103.5, Hawaii Revised Statutes,
 
22 is amended by amending subsection (a) to read as follows:
 

 
 
 
Page 8                                                     743
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1      "(a)  Personal injury protection benefits, with respect to
 
 2 any accidental harm, means all appropriate and reasonable
 
 3 treatment and expenses necessarily incurred as a result of the
 
 4 accidental harm and which are substantially comparable to the
 
 5 requirements for prepaid health care plans, including medical,
 
 6 hospital, surgical, professional, nursing, dental, optometric,
 
 7 chiropractic, ambulance, prosthetic services, products and
 
 8 accommodations furnished, x-ray, psychiatric, physical therapy
 
 9 pursuant to prescription by a medical doctor, occupational
 
10 therapy, rehabilitation, advanced practice nursing as recognized
 
11 in section 457-8.5, and therapeutic massage by a licensed massage
 
12 therapist when prescribed by a medical doctor."
 
13      SECTION 5.  Statutory material to be repealed is bracketed.
 
14 New statutory material is underscored.
 
15      SECTION 6.  This Act shall take effect upon its approval.