STAND. COM. REP. NO. 3735

Honolulu, Hawaii

RE: S.C.R. No. 241

S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-First State Legislature

Regular Session of 2022

State of Hawaii

Sir:

Your Committees on Commerce and Consumer Protection and Health, to which was referred S.C.R. No. 241 entitled:

"SENATE CONCURRENT RESOLUTION REQUESTING THE AUDITOR TO ASSESS THE SOCIAL AND FINANCIAL EFFECTS OF MANDATORY HEALTH INSURANCE COVERAGE FOR FERTILITY PRESERVATION PROCEDURES FOR CERTAIN PERSONS WHO HAVE BEEN DIAGNOSED WITH CANCER AND WHOSE CANCER OR CANCER TREATMENT MAY ADVERSELY AFFECT THEIR FERTILITY,"

beg leave to report as follows:

The purpose and intent of this measure is to request the Auditor to assess the social and financial effects of mandatory health insurance coverage for fertility preservation procedures for certain persons who have been diagnosed with cancer and whose cancer or cancer treatment may adversely affect their fertility.

Your Committees received testimony in support of this measure from Alliance for Fertility Preservation, Hawaii Society of Clinical Oncology, Association for Clinical Oncology, and Kaiser Permanente Hawaii. Your Committees received comments on this measure from Hawaii Medical Service Association and Hawaii Association of Health Plans.

Your Committees find that hundreds of Hawaii residents are diagnosed with cancer each year while still in their reproductive years (under age forty-five). Despite high survival rates, many treatments can have permanent effects on patients' reproductive systems and can lead to infertility. Senate Bill No. 3308, introduced in the Regular Session of 2022, would require Hawaii insurance companies to include, as a benefit, fertility preservation procedures for men and women of reproductive age who have been diagnosed with cancer and whose cancer treatment may adversely affect their fertility. Pursuant to the requirements of sections 23-51 and 23-52, Hawaii Revised Statutes, this measure requests the Auditor to prepare and submit a report to the Legislature that assesses both the social and financial effects of the proposed mandated coverage in Senate Bill No. 3308 (2022).

Your Committees have amended this measure by:

(1) Inserting language requesting the Auditor to include in the impact assessment report a survey of other states in the United States that have implemented a mandate for cryopreservation benefits for those diagnosed with cancer and to examine what the social and financial impact has been in those states;

(2) Requesting the Auditor to research whether the proposed cryopreservation coverage for those diagnosed with cancer constitutes benefits that are in excess of the essential health benefits, thus requiring the State to defray such costs;

(3) Requesting the Auditor to research the standard medical definition of "reproductive age" and to examine the success rates for the different age groups to determine coverage benefit limitations, including an examination of whether different standards of infertility treatments are applied to different age groups for those diagnosed with cancer;

(4) Requesting the Auditor to research public and private entities that provide the proposed coverage for cryopreservation procedures for those diagnosed with cancer and to determine standards of coverage, including what, if any, cost limitations are placed on this coverage benefit;

(5) Requesting the Auditor to examine current medically necessary standards of care used to determine what types of infertility treatment options are available, at a more cost-effective savings than the proposed cryopreservation procedures, which may be best suited for individuals diagnosed with cancer, and to examine the existing technology in infertility procedures and possible future technology;

(6) Requesting the Auditor to examine current scientific studies and current medical literature relating to the efficacy of the proposed cryopreservation procedures for those diagnosed with cancer;

(7) Requesting the Auditor to examine whether the scope of coverage for those "diagnosed with a cancer that may, or whose treatment may, adversely affect the fertility of the insured" is limited to medically necessary fertility preservation treatments for "iatrogenic infertility", meaning an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes;

(8) Requesting the Auditor to research certain ethical and legal issues surrounding the rights and entitlements with respect to the cryopreserved material; and

(9) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

As affirmed by the records of votes of the members of your Committees on Commerce and Consumer Protection and Health that are attached to this report, your Committees concur with the intent and purpose of S.C.R. No. 241, as amended herein, and recommend its adoption in the form attached hereto as S.C.R. No. 241, S.D. 1.

Respectfully submitted on behalf of the members of the Committees on Commerce and Consumer Protection and Health,

________________________________ JARRETT KEOHOKALOLE, Chair

________________________________ ROSALYN H. BAKER, Chair