SB444

SECTION 1. 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- Primary care provider; naturopathic physician. (a) Each policy of accident and health or sickness insurance delivered or issued for delivery in this State shall recognize naturopathic physicians licensed pursuant to chapter 455 as participating providers and shall include coverage for care provided by participating naturopathic physicians practicing within the scope of their licenses for purposes of health maintenance, diagnosis, or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

(b) Notwithstanding any other law to the contrary, an insurer may recognize a participating naturopathic physician as a primary care provider if the insured's policy requires the selection of a primary care provider. The insurer shall include participating naturopathic physicians who practice as primary care providers on any publicly available list of participating primary care providers; provided that the insurer retains the right to determine the contracting criteria for a participating primary care provider.

(c) The insurance commissioner shall receive and investigate complaints regarding potential violations of the nondiscrimination provisions established in section 2706 of the Public Health Service Act, title 42 United States Code section 300gg-5.

(d) For the purposes of this section, "participating naturopathic physician" means a naturopathic physician who has contracted with the insurer to provide health care services to the insurer's insureds."

SECTION 2. 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- Primary care provider; naturopathic physician. (a) Each individual or group hospital or medical plan contract delivered or issued for delivery in this State by a mutual benefit society shall recognize naturopathic physicians licensed pursuant to chapter 455 as participating providers and shall include coverage for care provided by participating naturopathic physicians practicing within the scope of their licenses for purposes of health maintenance, diagnosis, or treatment to the extent that the plan contract provides benefits for identical services rendered by another health care provider.

(b) Notwithstanding any other law to the contrary, a mutual benefit society may recognize a participating naturopathic physician as a primary care provider if the member's plan contract requires the selection of a primary care provider. The mutual benefit society shall include participating naturopathic physicians who practice as primary care providers on any publicly available list of participating primary care providers; provided that the mutual benefit society retains the right to determine the contracting criteria for a participating primary care provider.

(d) For the purposes of this section, "participating naturopathic physician" means a naturopathic physician who has contracted with the mutual benefit society to provide health care services to the society's members."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 2 to be appropriately designated and to read as follows:

"§432:2- Primary care provider; naturopathic physician. (a) Each benefit contract delivered or issued for delivery in this State by a fraternal benefit society shall recognize naturopathic physicians licensed pursuant to chapter 455 as participating providers and shall include coverage for care provided by participating naturopathic physicians practicing within the scope of their licenses for purposes of health maintenance, diagnosis, or treatment to the extent that the benefit contract provides benefits for identical services rendered by another health care provider.

(b) Notwithstanding any other law to the contrary, a fraternal benefit society may recognize a participating naturopathic physician as a primary care provider if the member's benefit contract requires the selection of a primary care provider. The fraternal benefit society shall include participating naturopathic physicians who practice as primary care providers on any publicly available list of participating primary care providers; provided that the fraternal benefit society retains the right to determine the contracting criteria for a participating primary care provider.

(d) For the purposes of this section, "participating naturopathic physician" means a naturopathic physician who has contracted with the fraternal benefit society to provide health care services to the society's members."

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

"§432D- Primary care provider; naturopathic physician. (a) Each individual or group health maintenance organization policy, contract, plan, or agreement delivered or issued for delivery in this State shall recognize naturopathic physicians licensed pursuant to chapter 455 as participating providers and shall include coverage for care provided by participating naturopathic physicians practicing within the scope of their licenses for purposes of health maintenance, diagnosis, or treatment to the extent that the policy, contract, plan, or agreement provides benefits for identical services rendered by another health care provider.

(b) Notwithstanding any other law to the contrary, a health maintenance organization may recognize a participating naturopathic physician as a primary care provider if the enrollee's policy, contract, plan, or agreement requires the selection of a primary care provider. The health maintenance organization shall include participating naturopathic physicians who practice as primary care providers on any publicly available list of participating primary care providers; provided that the health maintenance organization retains the right to determine the contracting criteria for a participating primary care provider.

(d) For the purposes of this section, "participating naturopathic physician" means a naturopathic physician who has contracted with the health maintenance organization to provide health care services to the health maintenance organization's enrollees."

SECTION 5. Section 431:10A-115.5, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

"(e) For the purposes of this section, "child health supervision services" means [~~physician-delivered, physician-supervised, physician assistant-delivered, or nurse-delivered services as defined by section 457-2 ("registered nurse")~~] services supervised by a physician or osteopathic physician licensed pursuant to chapter 453 or services delivered by a physician or osteopathic physician licensed pursuant to chapter 453, a naturopathic physician licensed pursuant to chapter 455, or a registered nurse licensed pursuant to chapter 457, which shall include as the minimum benefit coverage for services delivered at intervals and scope stated in this section."

SECTION 6. Section 431:10A-116, Hawaii Revised Statutes, is amended to read as follows:

"§431:10A-116 Coverage for specific services. Every person insured under a policy of accident and health or sickness insurance delivered or issued for delivery in this State shall be entitled to the reimbursements and coverages specified below:

(1) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any visual or optometric service, which is within the lawful scope of practice of a duly licensed optometrist, the person entitled to benefits or the person performing the services shall be entitled to reimbursement whether the service is performed by a licensed physician or by a licensed optometrist. Visual or optometric services shall include eye or visual examination, [~~or both,~~] or a correction of any visual or muscular anomaly[,] and the supplying of ophthalmic materials, lenses, contact lenses, spectacles, eyeglasses, and appurtenances thereto;

(2) Notwithstanding any provision to the contrary, for all policies, contracts, plans, or agreements issued on or after May 30, 1974, whenever provision is made for reimbursement or indemnity for any service related to surgical or emergency procedures, which is within the lawful scope of practice of any practitioner licensed to practice medicine in this State, reimbursement or indemnification under the policy, contract, plan, or agreement shall not be denied when the services are performed by a dentist acting within the lawful scope of the dentist's license;

(3) Notwithstanding any provision to the contrary, whenever the policy provides reimbursement or payment for any service, which is within the lawful scope of practice of a psychologist licensed in this State, the person entitled to benefits or performing the service shall be entitled to reimbursement or payment[,] whether the service is performed by a licensed physician or licensed psychologist;

(4) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article 1 shall provide coverage for screening by low-dose mammography for occult breast cancer as follows:

(A) For women forty years of age and older, an annual mammogram; and

(B) For a woman of any age with a history of breast cancer or whose mother or sister has had a history of breast cancer, a mammogram upon the recommendation of the woman's physician.

The services provided in this paragraph are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements.

For the purpose of this paragraph, the term "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast. An insurer may provide the services required by this paragraph through contracts with providers; provided that the contract is determined to be a cost-effective means of delivering the services without sacrifice of quality and meets the approval of the director of health;

(5) (A) (i) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides coverage for the children of the insured, that coverage shall also extend to the date of birth of any newborn child to be adopted by the insured; provided that the insured gives written notice to the insurer of the insured's intent to adopt the child prior to the child's date of birth [or], within thirty days after the child's birth, or within the time period required for enrollment of a natural born child under the policy, contract, plan, or agreement of the insured, whichever period is longer; provided further that if the adoption proceedings are not successful, the insured shall reimburse the insurer for any expenses paid for the child; and

(ii) Where notification has not been received by the insurer prior to the child's birth or within the specified period following the child's birth, insurance coverage shall be effective from the first day following the insurer's receipt of legal notification of the insured's ability to consent for treatment of the infant for whom coverage is sought; and

(B) When the insured is a member of a health maintenance organization [~~(HMO)~~], coverage of an adopted newborn is effective:

(i) From the date of birth of the adopted newborn when the newborn is treated from birth pursuant to a provider contract with the health maintenance organization, and written notice of enrollment in accord with the health maintenance organization's usual enrollment process is provided within thirty days of the date the insured notifies the health maintenance organization of the insured's intent to adopt the infant for whom coverage is sought; or

(ii) From the first day following receipt by the health maintenance organization of written notice of the insured's ability to consent for treatment of the infant for whom coverage is sought and enrollment of the adopted newborn in accord with the health maintenance organization's usual enrollment process if the newborn has been treated from birth by a provider not contracting or affiliated with the health maintenance organization; and

(6) Notwithstanding any provision to the contrary, any policy, contract, plan, or agreement issued or renewed in this State shall provide reimbursement for services within the respective allowable scope of practice provided by advanced practice registered nurses licensed pursuant to chapter 457[.] and naturopathic physicians licensed pursuant to chapter 455. Services rendered by advanced practice registered nurses and naturopathic physicians are subject to the same policy limitations generally applicable to health care providers within the policy, contract, plan, or agreement."

SECTION 7. Section 431:10A-120, Hawaii Revised Statutes, is amended to read as follows:

"§431:10A-120 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) Each policy of accident and health or sickness insurance, other than life insurance, disability income insurance, and long-term care insurance, issued or renewed in this State, each employer group health policy, contract, plan, or agreement issued or renewed in this State, all accident and health or sickness insurance policies issued or renewed in this State, all policies providing family coverages as defined in section 431:10A-103, and all policies providing reciprocal beneficiary family coverage as defined in section 431:10A-601, shall contain a provision for coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism for its policyholders or dependents of the policyholder in this State; provided that the medical food or low-protein modified food product is:

(1) Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and

(2) Consumed or administered enterally under the supervision of a physician or osteopathic physician licensed under chapter 453[.] or a naturopathic physician licensed under chapter 455.

Coverage shall be for at least eighty per cent of the cost of the medical food or low-protein modified food product prescribed and administered pursuant to this subsection.

(b) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to policyholders [and shall be transmitted to policyholders during calendar year 2000 when annual information is made available to policyholders, or in any other mailing to policyholders, but in no case later than December 31, 2000].

"Inborn error of metabolism" means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat.

"Low-protein modified food product" means a food product that:

(1) Is specially formulated to have less than one gram of protein per serving;

(2) Is prescribed or ordered by a physician [or], osteopathic physician, or naturopathic physician as medically necessary for the dietary treatment of an inborn error of metabolism; and

(3) Does not include a food that is naturally low in protein.

"Medical food" means a food that is formulated to be consumed or administered enterally under the supervision of a physician [or], osteopathic physician, or naturopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."

SECTION 8. Section 431:10A-206.5, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

"(e) For the purposes of this section, "child health supervision services" means [~~physician-delivered, physician-supervised, physician assistant-delivered, or nurse-delivered services as defined by section 457-2 ("registered nurse"),~~] services supervised by a physician or osteopathic physician licensed pursuant to chapter 453 or services delivered by a physician or osteopathic physician licensed pursuant to chapter 453, a naturopathic physician licensed pursuant to chapter 455, or a registered nurse licensed pursuant to chapter 457 which shall include as the minimum benefit coverage for services delivered at intervals and scope stated in this section."

SECTION 9. Section 432:1-602.5, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

"(e) For the purposes of this section, "child health supervision services" means [~~physician-delivered, physician-supervised, physician assistant-delivered, or nurse-delivered services as defined by section 457-2 ("registered nurse"),~~] services supervised by a physician or osteopathic physician licensed pursuant to chapter 453 or services delivered by a physician or osteopathic physician licensed pursuant to chapter 453, a naturopathic physician licensed pursuant to chapter 455, or a registered nurse licensed pursuant to chapter 457, which shall include as the minimum benefit coverage for services delivered at intervals and scope stated in this section."

SECTION 10. Section 432:1-609, Hawaii Revised Statutes, is amended to read as follows:

"§432:1-609 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) All individual and group hospital and medical service plan contracts and medical service corporation contracts under this chapter shall provide coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism for its members or dependents of the member in this State; provided that the medical food or low-protein modified food product is:

(1) Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and

(2) Consumed or administered enterally under the supervision of a physician or osteopathic physician licensed under chapter 453[.] or a naturopathic physician licensed under chapter 455.

Coverage shall be for at least eighty per cent of the cost of the medical food or low-protein modified food product prescribed and administered pursuant to this subsection.

(b) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to members [~~and shall be transmitted to members during calendar year 2000 when annual information is made available to members, or in any other mailing to members, but in no case later than December 31, 2000~~].

"Low-protein modified food product" means a food product that:

(1) Is specially formulated to have less than one gram of protein per serving;

(2) Is prescribed or ordered by a physician [or], osteopathic physician, or naturopathic physician as medically necessary for the dietary treatment of an inherited metabolic disease; and

(3) Does not include a food that is naturally low in protein.

SECTION 11. Section 432D-1, Hawaii Revised Statutes, is amended by amending the definition of "provider" to read as follows:

""Provider" means any physician, naturopathic physician practicing within the scope of licensure, hospital, or other person licensed or otherwise authorized to furnish health care services."

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect on July 1, 2019.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	444
THIRTIETH LEGISLATURE, 2019
STATE OF HAWAII