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THE SENATE |
S.B. NO. |
3133 |
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THIRTY-THIRD LEGISLATURE, 2026 |
S.D. 2 |
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STATE OF HAWAII |
H.D. 3 |
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A BILL FOR AN ACT
RELATING TO PREVENTIVE MEDICINE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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.
The purpose of this Act is to:
(1) Specify that no person is subject to liability for providing clinical preventive services in accordance with department of health recommendations;
(2) Require health insurers, mutual benefit societies, health maintenance organizations, and plans issued by the Hawaii employer-union health benefits trust fund to provide coverage for clinical preventive services;
(3) Authorize the department of health to make recommendations relating to clinical preventive services and issue standing orders for medications and immunizations;
(4) Clarify that for child health supervision services coverage, the prevailing medical standards include recommendations by the department of health;
(5) Prohibit the denial of coverage and prior authorization for clinical preventive services based on medical necessity; and
(6) Specify that a registered pharmacist may order a vaccine in accordance with department of health recommendations.
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 10A, 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 1, 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 or 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.
(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 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 subsections (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]; provided 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:
"(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]; provided 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 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:
"(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]; provided 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 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-134, 431:10A-140, and [431:10A-134,]
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.
Report Title:
DOH; Insurance; Preventive Services Coverage; Recommendations; Standing Orders; Child Health Supervision Services; Immunization; Prevailing Medical Standards; Pharmacists; EUTF
Description:
Specifies that no person is subject to liability for providing clinical preventive services in accordance with Department of Health recommendations. Requires health insurers, mutual benefit societies, health maintenance organizations, and plans issued by the Hawaii Employer-Union Health Benefits Trust Fund to provide coverage for clinical preventive services. Authorizes the Department of Health to make recommendations relating to clinical preventive services and issue standing orders for medications and immunizations. Clarifies that, for child health supervision services coverage, the prevailing medical standards include recommendations by the Department of Health. Prohibits denial of coverage and prior authorization for clinical preventive services based on medical necessity. Specifies that a registered pharmacist may order a vaccine in accordance with the recommendations from the Department of Health. Exempts this measure from an Auditor impact assessment report. Effective 7/1/3000. (HD3)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.