SB2428

SECTION 1. The legislature finds that cognitive assessments are crucial for early detection and management of cognitive impairments such as dementia and Alzheimer's disease. Early diagnosis can significantly improve the quality of life for affected individuals and reduce long-term health care costs.

The legislature further finds that research shows that certain populations face elevated risks for developing dementia. By age forty, most individuals with Down syndrome have beta-amyloid plaques and tau tangles in the brain, which disrupt normal cell function and significantly increase the likelihood of Alzheimer's symptoms. Estimates suggest that fifty per cent or more of individuals with Down syndrome will develop dementia due to Alzheimer's disease as they age.

The legislature additionally finds that Native Hawaiians suffer from higher rates of Alzheimer's disease and related dementias; are often diagnosed at younger ages; and despite earlier diagnosis, tend to be in later stages of the disease at the time of detection. This disparity underscores the urgent need for proactive screening and intervention.

Furthermore, common risk factors such as diabetes, hypertension, smoking, lack of physical activity, and poor diet contribute to cognitive decline and increase the likelihood of dementia. Detecting cognitive changes early allows health care providers to address these risks preventively, implement care planning, and connect individuals to supportive services before significant decline occurs.

Moreover, the legislature notes that when health care providers order certain evidence-based preventive services, such as a brief emotional and behavioral assessment, these are widely reimbursed at a modest rate by medicare, medicaid, and private insurance, incentivizing early detection and intervention for behavioral health. Similarly, coverage for brief cognitive assessments would provide a cost-effective mechanism to identify cognitive changes early, reduce long-term health care costs, and improve outcomes for individuals at risk of dementia.

Therefore, the purpose of this Act is to require insurance coverage for brief cognitive assessments for individuals fifty years of age and older during routine and nonroutine visits, ensuring that cognitive changes are identified early and managed effectively.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431:10A- Cognitive assessments; coverage. (a) Each individual or group policy of accident and health or sickness insurance issued or renewed in the State on or after January 1, 2027, shall provide coverage for brief cognitive assessment screening for the policyholder or any dependent of the policyholder covered under the policy.

(b) Coverage required under this section shall include but not be limited to:

(1) Initial cognitive assessments during routine visits for individuals fifty years of age and older; and

(2) Initial cognitive assessments during non-routine visits for individuals fifty years of age and older.

(c) This section shall not prohibit an insurer from providing coverage that is greater or more favorable to the policyholder and any dependent of the policyholder covered under the policy.

(d) Coverage required under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, and annual or maximum payment limits applicable to other similar coverage under the policy.

(e) Annual information that is made available to policyholders shall include information concerning the coverage required by this section.

(f) This section shall not apply to limited benefit health insurance as provided in section 431:10A-607.

(g) As used in this section:

"Cognitive assessment" means a validated evaluation of an individual's cognitive functions, including memory, attention, language, and problem-solving abilities, conducted using validated tools and procedures.

"Screening" means the process of identifying individuals who may be at risk for cognitive impairments through brief, validated tests.

"Validated tools" means assessment instruments that have been scientifically tested and proven to accurately measure cognitive functions."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

"§432:1- Cognitive assessments; coverage. (a) Each individual or group hospital or medical service plan contract issued or renewed in the State on or after January 1, 2027, shall provide coverage for brief cognitive assessment screening for the subscriber or member or any dependent of the subscriber or member covered under the plan contract.

(b) Coverage for brief cognitive assessments shall include but not be limited to:

(1) Initial cognitive assessments during routine visits for individuals fifty years of age and older; and

(2) Initial cognitive assessments during non-routine visits for individuals fifty years of age and older.

(c) This section shall not prohibit a mutual benefit society from providing coverage that is greater or more favorable to the subscriber or member and any dependent of the subscriber or member covered under the plan contract.

(e) Annual information that is made available to subscribers and members shall include information concerning the coverage required by this section.

(f) As used in this section:

"Screening" means the process of identifying individuals who may be at risk for cognitive impairments through brief, validated tests.

"Validated tools" means assessment instruments that have been scientifically tested and proven to accurately measure cognitive functions."

SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [~~431:10A-134,~~] 431:10A- , and chapter 431M."

SECTION 5. The benefits and coverage to be provided by health maintenance organizations under section 4 of this Act shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State on or after January 1, 2027.

SECTION 6. (a) The reimbursement for brief cognitive assessments for individuals fifty years of age and older required under sections 2 and 3 of this Act shall apply to all health plans under the medicaid managed care program in the State.

(b) The department of human services shall submit the necessary amendments to the Hawaii medicaid state plan to the Centers for Medicare and Medicaid Services no later than .

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect on July 1, 2026; provided that section 6 of this Act shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2428
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII