REPORT TITLE:
Optometrists


DESCRIPTION:
Requires health insurance companies to reimburse optometrists to
the same extent as opthamologists for the same service.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           1263
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO OPTOMETRISTS. 


BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  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           provided that a licensed optometrist shall be
 
16           reimbursed to the same extent as a licensed
 
17           opthalmologist for identical eye care services.  Visual
 
18           or optometric services shall include eye or visual
 
19           examination, or both, or a correction of any visual or
 

 
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                                     S.B. NO.           1263
                                                        
                                                        

 
 1           muscular anomaly, and the supplying of opthalmic
 
 2           materials, lenses, contact lenses, spectacles,
 
 3           eyeglasses, and appurtenances thereto.
 
 4      (2)  Notwithstanding any provision to the contrary, for all
 
 5           policies, contracts, plans, or agreements issued on or
 
 6           after May 30, 1974, whenever provision is made for
 
 7           reimbursement or indemnity for any service related to
 
 8           surgical or emergency procedures which is within the
 
 9           lawful scope of practice of any practitioner licensed
 
10           to practice medicine in this State, reimbursement or
 
11           indemnification under such policy, contract, plan, or
 
12           agreement shall not be denied when such services are
 
13           performed by a dentist acting within the lawful scope
 
14           of the dentist's license.
 
15      (3)  Notwithstanding any provision to the contrary, whenever
 
16           the policy provides reimbursement or payment for any
 
17           service which is within the lawful scope of practice of
 
18           a psychologist licensed in this State, the person
 
19           entitled to benefits or performing the service shall be
 
20           entitled to reimbursement or payment, whether the
 
21           service is performed by a licensed physician or
 
22           licensed psychologist.
 
23      (4)  Notwithstanding any provision to the contrary, each
 

 
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                                     S.B. NO.           1263
                                                        
                                                        

 
 1           policy, contract, plan, or agreement issued on or after
 
 2           February 1, 1991, except for policies which only
 
 3           provide coverage for specified diseases or other
 
 4           limited benefit coverage, but including policies issued
 
 5           by companies subject to chapter 431, article 10A, part
 
 6           II and chapter 432, article 1 shall provide coverage
 
 7           for screening by low-dose mammography for occult breast
 
 8           cancer as follows:
 
 9           (A)  For women thirty-five to thirty-nine years of age,
 
10                one baseline mammogram;
 
11           (B)  For women forty to forty-nine years of age, a
 
12                mammogram every two years;
 
13           (C)  For women fifty years of age and older, an annual
 
14                mammogram; and
 
15           (D)  For a woman of any age with a history of breast
 
16                cancer or whose mother or sister has had a history
 
17                of breast cancer, a mammogram upon the
 
18                recommendation of the woman's physician.
 
19                The services provided in this paragraph are
 
20           subject to any coinsurance provisions which may be in
 
21           force in these policies, contracts, plans, or
 
22           agreements.  The commissioner shall annually review the
 
23           age and frequency guidelines for mammographic screening
 

 
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                                     S.B. NO.           1263
                                                        
                                                        

 
 1           recommended by the American Cancer Society, and shall
 
 2           accordingly adjust the age and frequency requirements
 
 3           under subparagraphs (A) to (C) by rule, if necessary.
 
 4                For the purpose of this paragraph, the term "low-
 
 5           dose mammography" means the x-ray examination of the
 
 6           breast using equipment dedicated specifically for
 
 7           mammography, including but not limited to the x-ray
 
 8           tube, filter, compression device, screens, films, and
 
 9           cassettes, with an average radiation exposure delivery
 
10           of less than one rad mid-breast, with two views for
 
11           each breast.  An insurer may provide the services
 
12           required by this paragraph through contracts with
 
13           providers; provided that the contract is determined to
 
14           be a cost-effective means of delivering the services
 
15           without sacrifice of quality and meets the approval of
 
16           the director of health.
 
17      (5)  (A)  (i)  Notwithstanding any provision to the
 
18                     contrary, whenever a policy, contract, plan,
 
19                     or agreement provides coverage for the
 
20                     children of the insured, that coverage shall
 
21                     also extend to the date of birth of any
 
22                     newborn child to be adopted by the insured;
 
23                     provided that the insured gives written
 

 
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                                     S.B. NO.           1263
                                                        
                                                        

 
 1                     notice to the insurer of the insured's
 
 2                     intent to adopt the child prior to the
 
 3                     child's date of birth or within thirty days
 
 4                     after the child's birth or within the time
 
 5                     period required for enrollment of a natural
 
 6                     born child under the policy, contract plan,
 
 7                     or agreement of the insured, whichever period
 
 8                     is longer; provided, however, if the adoption
 
 9                     proceedings are not successful, the insured
 
10                     shall reimburse the insurer for any expenses
 
11                     paid for the child.
 
12               (ii)  Where notification has not been received by
 
13                     the insurer prior to the child's birth or
 
14                     within the specified period following the
 
15                     child's birth, insurance coverage shall be
 
16                     effective from the first day following the
 
17                     insurer's receipt of legal notification of
 
18                     the insured's ability to consent for
 
19                     treatment of the infant for whom coverage is
 
20                     sought.
 
21           (B)  When the insured is a member of a health
 
22                maintenance organization (HMO), coverage of an
 
23                adopted newborn is effective:
 

 
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                                     S.B. NO.           1263
                                                        
                                                        

 
 1                (i)  From the date of birth of the adopted newborn
 
 2                     when the newborn is treated from birth
 
 3                     pursuant to a provider contract with the
 
 4                     health maintenance organization, and written
 
 5                     notice of enrollment in accord with the
 
 6                     health maintenance organization's usual
 
 7                     enrollment process is provided within thirty
 
 8                     days of the date the insured notifies the
 
 9                     health maintenance organization of the
 
10                     insured's intent to adopt the infant for whom
 
11                     coverage is sought; or
 
12               (ii)  From the first day following receipt by the
 
13                     health maintenance organization of written
 
14                     notice of the insured's ability to consent
 
15                     for treatment of the infant for whom coverage
 
16                     is sought and enrollment of the adopted
 
17                     newborn in accord with the health maintenance
 
18                     organization's usual enrollment process if
 
19                     the newborn has been treated from birth by a
 
20                     provider not contracting or affiliated with
 
21                     the health maintenance organization."
 
22      SECTION 2.  Statutory material to be repealed is bracketed.
 
23 New statutory material is underscored.
 

 
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                                     S.B. NO.           1263
                                                        
                                                        

 
 1      SECTION 3.  This Act shall take effect upon its approval.
 
 2 
 
 3                           INTRODUCED BY:  _______________________