HB1898 HD2

SECTION 1. The legislature finds that recent changes to the immunization recommendations provided by the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services differ significantly from established medical standards and practice, such as the immunization recommendations provided by the American Academy of Pediatrics. The legislature also finds that insurance companies have only publicly committed to providing coverage of vaccines that were part of the Advisory Committee's recommendations made before September 2025 until the end of 2026. However, to protect the freedom of choice for the people of Hawaii to comprehensively consider the full range of prevailing medical standards when it comes to childhood immunization, there must be clarity regarding what their insurance will cover.

The legislature further finds that the loss of no-cost access to these preventive services would likely increase out-of-pocket health care expenses for Hawaii residents, causing many individuals to delay or forego preventive care. Such delays would increase the risk of infectious disease outbreaks and contribute to the growing burden of chronic disease across the State.

Accordingly, the purpose of this Act is to reduce confusion, reduce barriers, and ensure access to science-based clinical preventive services for those that choose to receive these services.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to part II to be appropriately designated and to read as follows:

"§321- Preventive services; immunity. (a) No person shall be subject to civil or criminal liability or professional disciplinary action or deemed to have engaged in unprofessional conduct for providing clinical preventive services in accordance with recommendations made pursuant to section 321-31.

(b) No professional organization or association, health care provider, or health care facility shall subject any person to discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for providing clinical preventive services in accordance with recommendations made pursuant to section 321-31.

(c) Nothing in this section shall be construed to limit, restrict, or prohibit any claim, cause of action, or right of recovery against any person or entity for injury arising from negligence."

SECTION 3. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article I, part I, to be appropriately designated and to read as follows:

"§431:10A- Preventive services coverage; department of health recommendations. (a) Each individual policy of accident and health or sickness insurance delivered or issued for delivery in the State beginning January 1, 2027, shall provide coverage, without any deductible, copayment, coinsurance, or other cost-sharing requirements, for clinical preventive services recommended by the department of health pursuant to section 321-31.

(b) Coverage under this section shall include items and services furnished by a provider acting within the scope of the provider's license.

(c) This section shall not be construed to limit any broader coverage or benefits related to preventive services otherwise required under this chapter.

(d) This section shall not apply to disability income, specified disease, medicare supplement, hospital indemnity policies, or any health insurance policy for which federal law would require the State to pay the defrayal cost of otherwise noncovered state mandated benefits."

SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article I, part VI, to be appropriately designated and to read as follows:

"§432:1- Preventive services coverage; department of health recommendations. (a) Each individual or group hospital and medical service plan contract delivered or issued for delivery in the State beginning January 1, 2027, shall provide coverage, without any deductible, copayment, coinsurance, or other cost-sharing requirements, for clinical preventive services recommended by the department of health pursuant to section 321-31.

(b) Coverage under this section shall include items and services furnished by a provider acting within the scope of the provider's license.

(c) This section shall not be construed to limit any broader coverage or benefits related to preventive services otherwise required under this chapter.

SECTION 5. Section 321-31, Hawaii Revised Statutes, is amended to read as follows:

"§321-31 Functions of the department. The powers, duties, and functions of the department of health relating to preventive medicine shall be as follows:

(1) To supervise and coordinate activities in the fields of preventive medicine, including cancer control, crippled children, epidemiology, geriatrics, laboratories, maternal and child health, mental hygiene, nutrition, and communicable diseases;

(2) To formulate and put into effect throughout the State educational programs for the purposes of preventing and reducing disease and disability;

(3) To engage in the collection and analysis of statistical information pertinent to any of its activities;

(4) To cooperate with and propose methods and programs to other governmental agencies relating to the fields of preventive medicine;

(5) To serve as the coordinating agency for programs [~~which~~] that provide for a range of child abuse and neglect prevention services in relation to assessed needs, regardless of whether the programs are conducted by the department, other government agencies, or private organizations and to coordinate the prevention programs with child abuse and neglect treatment services; provided that this paragraph shall not be interpreted to compel a specified level of services; [~~and~~]

(6) To make recommendations relating to clinical preventive service recommendations of the United States Preventive Services Task Force that have been assigned a grade of A or B as of July 1, 2025, and relating to immunizations;

(7) To issue standing orders for medications and immunizations; and

[~~(6)~~] (8) To perform such other appropriate functions as may be required."

SECTION 6. Section 431:10A-115.5, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (b) and (c) to read:

"(b) Child health supervision services shall include twelve visits at approximately the following intervals: birth; two months; four months; six months; nine months; twelve months; fifteen months; eighteen months; two years; three years; four years; and five years. Services to be covered at each visit shall include a history, physical examination, developmental assessment, anticipatory guidance, immunizations, and laboratory tests, in keeping with the prevailing medical standards. [For purposes of this subsection, the term "prevailing medical standards" means the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services and the American Academy of Pediatrics; provided that if the recommendations of the committee and the academy differ, the department of health shall determine which recommendations shall apply.]

(c) Minimum benefits may be limited to one visit payable to one provider for all of the services provided at each visit cited in this section, except that the limitations authorized by this subsection shall not apply to immunizations [recommended by the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services and the American Academy of Pediatrics; provided that if the recommendations of the committee and the academy differ, the department of health shall determine which recommendations shall apply.] in keeping with the prevailing medical standards."

2. By amending subsection (e) to read:

"(e) For the purposes of this section[~~, "child~~]:

"Child health supervision services" means physician-delivered, physician-supervised, physician assistant-delivered, or nurse-delivered services as defined by section 457-2 ("registered nurse") , which shall include as the minimum benefit coverage for services delivered at intervals and scope stated in this section.

"Prevailing medical standards" means the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services and the American Academy of Pediatrics, or the recommendations of the department of health made pursuant to section 321-31; provided that if these recommendations differ, the department of health shall determine which recommendations shall apply."

SECTION 7. Section 431:10A-206.5, Hawaii Revised Statutes, is amended as follows:

1. By amending subsections (b) and (c) to read:

2. By amending subsection (e) to read:

"(e) For the purposes of this section[~~, "child~~]:

"Child health supervision services" means physician-delivered, physician-supervised, physician assistant-delivered, or nurse-delivered services as defined by section 457-2 ("registered nurse"), which shall include as the minimum benefit coverage for services delivered at intervals and scope stated in this section.

SECTION 8. Section 431:10A-207, Hawaii Revised Statutes, is amended to read as follows:

"§431:10A-207 Coverage for specific services. Every person insured under a group or blanket disability insurance policy shall be entitled to the reimbursements and coverages specified in [~~section~~] sections 431:10A-116[.] and 431:10A- ."

SECTION 9. Section 432:1-602.5, Hawaii Revised Statutes, is amended as follows:

1. By amending subsections (b) and (c) to read:

2. By amending subsection (e) to read:

"(e) For the purposes of this section[~~, "child~~]:

"Child health supervision services" means physician-delivered, physician-supervised, physician assistant-delivered, or nurse-delivered services as defined by section 457-2 ("registered nurse"), which shall include as the minimum benefit coverage for services delivered at intervals and scope stated in this section.

SECTION 10. 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-140, [~~and~~] 431:10A-134, and 431:10A- , and chapter 431M."

SECTION 11. Section 432E-1.4, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) For contractual purposes, a health intervention shall be covered if it is an otherwise covered category of service, not specifically excluded, recommended by the treating licensed health care provider, and determined by the health plan's medical director to be medically necessary as defined in subsection (b). Notwithstanding any determination under this section, coverage for any clinical preventive service for which coverage is required under state law or rule, including clinical preventive services recommended by the department of health pursuant to section 321-31, shall not be denied on the basis of medical necessity or subject to prior authorization, except as permitted for reasonable medical management. A health intervention may be medically indicated and not qualify as a covered benefit or meet the definition of medical necessity. A managed care plan may choose to cover health interventions that do not meet the definition of medical necessity."

SECTION 12. Section 461-11.4, Hawaii Revised Statutes, is amended by amending its title and subsection (a) to read as follows:

"§461-11.4 Vaccinations[~~; children~~]. (a) A pharmacist, pharmacy intern, or registered pharmacy technician under the direct supervision of a registered pharmacist may administer a vaccine to a person three years of age or older; provided that:

(1) The vaccine is authorized or approved by the United States Food and Drug Administration[;] for any indication;

(2) The vaccine has been ordered by a registered pharmacist and administered in accordance with the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services[;], or the department of health pursuant to section 321-31;

(3) The pharmacy intern has completed a practical training program approved by the Accreditation Council for Pharmacy Education that includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency responses to vaccines;

(4) The registered pharmacy technician has completed a practical training program approved by the Accreditation Council for Pharmacy Education that includes hands-on injection technique;

(5) The registered pharmacy technician has a Certified Pharmacy Technician certification from either the Pharmacy Technician Certification Board or National Healthcareer Association;

(6) The registered pharmacist, pharmacy intern, or registered pharmacy technician has a current certificate in basic cardiopulmonary resuscitation;

(7) The registered pharmacist or registered pharmacy technician has completed a minimum of two credit hours in immunization-related continuing education courses during each licensing biennium;

(8) The registered pharmacist is in compliance with all applicable recordkeeping and reporting requirements, including complying with adverse events reporting requirements;

(9) The registered pharmacist, pharmacy intern, or registered pharmacy technician has reviewed the patient's vaccination records before administering the vaccine;

(10) The registered pharmacist has informed the patient and the patient's primary guardian or caregiver of the importance of a well-child visit with a pediatrician or other licensed primary care provider and has referred the patient as appropriate; and

(11) Where a prescription has been ordered by a person other than the registered pharmacist[,] or a standing order pursuant to section 321-31, the registered pharmacist, pharmacy intern, or registered pharmacy technician shall verify that the prescriber or the prescriber's authorized agent is the patient's medical home."

SECTION 13. Notwithstanding sections 23-51 and 23-52, Hawaii Revised Statutes, this Act shall be exempt from the requirements for an impact assessment report on proposed mandatory health insurance coverage.

SECTION 14. The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10- , Hawaii Revised Statutes, if any, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 10 of this Act, shall take effect for all policies, contracts, plans, or agreements issued in the State from January 1, 2027.

SECTION 15. Notwithstanding any other law to the contrary, the coverage for evidence-based clinical preventive services required under sections 3, 4, 6, 7, 8, 9, 10, and 11 of this Act shall apply to all health benefits plans under chapter 87A, Hawaii Revised Statutes issued in the State from January 1, 2027.

SECTION 16. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 17. If any provision of this Act, or the application thereof to any person or circumstances, triggers a cost to the State pursuant to title 45 Code of Federal Regulations section 155.170, that provision shall be repealed but does not affect other provisions or applications of the Act that can be given effect without triggering costs to the State pursuant to title 45 Code of Federal Regulations section 155.170, and to this end the provisions of this Act are severable.

SECTION 18. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 19. This Act shall take effect on July 1, 3000.

HOUSE OF REPRESENTATIVES	H.B. NO.	1898
THIRTY-THIRD LEGISLATURE, 2026		H.D. 2
STATE OF HAWAII