HB687 HD1

SECTION 1. The legislature finds that port-wine stain is a discoloration of the human skin caused by a vascular anomaly, namely a capillary malformation in the skin. A port-wine stain is usually a birthmark, but in rare cases it can develop in early childhood. Studies have recorded an incidence of three-to-five cases per thousand newborn babies. Port-wine stains ordinarily persist throughout life.

Port-wine stains occur most often on the face but can appear anywhere on the body, particularly on the neck and upper trunk. If the port-wine stain is on the face or other highly visible part of the body, its presence can also cause emotional and social problems for the affected person. Early stains are usually flat and pink in appearance and as the child matures, the color may deepen to a dark red or purplish color. In adulthood, thickening of the lesion or the development of small lumps may occur. In the absence of successful treatment, hypertrophy, which is increased tissue mass of the stain, may cause problems later in life such as loss of proximate organ function especially near the eye or mouth, bleeding, and increasing disfigurement. Lesions on or near the eyelid can be associated with glaucoma. When port-wine stain proliferates around the eyelid, it may cause ectropion, the downward pulling of the lower eyelid, which may lead to corneal abrasion and loss of vision.

In the State Auditor's Report No. 18-20 "Study of Proposed Mandatory Health Insurance for Port-Wine Stains," it was cited that the majority of health care insurers surveyed said that medical treatments are deemed necessary when a patient experiences some functionality issues resulting from a port-wine stain.

The purpose of this Act is to require insurers, hospital and medical services plans, and health maintenance organizations to provide coverage for medical procedures to eliminate or provide maximum feasible treatment of port-wine stains that are deemed necessary when a patient experiences or, with medical certainty substantiated from a licensed physician, will experience some functionality issues resulting from a port-wine stain.
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- Port-wine stain coverage. (a) Notwithstanding any other law to the contrary, each individual or group health or sickness insurance plan, policy, contract, or agreement issued or renewed in the State after December 31, 2019, shall provide coverage for medically necessary procedures related to port-wine stain, for policyholders and individuals covered under the individual or group health or sickness insurance plan, policy, contract, or agreement. Coverage required pursuant to this section shall include any medically necessary procedures, including laser surgery, remediation, or necessary post-acute medical services required to eliminate or provide maximum feasible treatment for port-wine stain for up to twenty years from the date the port-wine stain was medically detected; provided that no insurer shall be required to pay more than $ per covered individual for medically necessary procedures, including laser surgery, remediation, and any necessary post-acute medical services subject to this section unless the insurance plan, policy, contract, or agreement states otherwise.

(b) 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, contract, plan, or agreement.

(c) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. Notice shall be posted on the insurer's website and provided via email to policyholders no later than January 1, 2020."

SECTION 3. 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- Port-wine stain coverage. (a) Notwithstanding any other law to the contrary, each individual or group hospital or medical service plan, policy, contract, or agreement issued or renewed in the State after December 31, 2019, shall provide coverage for medically necessary procedures related to port-wine stain, for members and individuals covered under a hospital or medical service plan, policy, contract, or agreement. Coverage required pursuant to this section shall include any medically necessary procedures, including laser surgery, remediation, or necessary post-acute medical services required to eliminate or provide maximum feasible treatment for port-wine stain for up to twenty years from the date the port-wine stain was medically detected; provided that no mutual benefit society shall be required to pay more than $ per covered individual for medically necessary procedures, laser surgery, remediation, and any necessary post-acute medical services subject to this section unless the hospital or medical service plan, policy, contract, or agreement states otherwise.

(c) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. Notice shall be posted on the insurer's website and provided via email to members no later than January 1, 2020."

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 provided by health maintenance organizations corresponding to the benefit provided under section 431:10A- , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 4 of this Act shall take effect for all policies, contracts, plans, or agreements issued in the State of Hawaii after December 31, 2019.

SECTION 6. The department of commerce and consumer affairs shall submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2021. The report shall explain the economic impact that the expanded coverage for port-wine stain under this Act has had on affected insurers.

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, 2050.

HOUSE OF REPRESENTATIVES	H.B. NO.	687
THIRTIETH LEGISLATURE, 2019		H.D. 1
STATE OF HAWAII