SB1041

SECTION 1. The legislature finds that the right of every individual to make informed decisions about their own health care is the foundation of patient autonomy and a fundamental part of public health policy. Access to transparent and comprehensive information about available medical procedures is essential for enabling patients to make knowledgeable choices about their care and treatment options.

The legislature further finds that nonmedical refusals to provide certain health care services based on nonmedical reasons, such as sterilization, abortion, contraceptive services, infertility treatments, or end-of-life care are often rooted in institutional policies or ideologies that are not explicitly disclosed to patients. These refusals disproportionately affect vulnerable and marginalized populations, including individuals from the LGBTQ+ community, people of low socioeconomic status, and those residing in rural or underserved areas.

The legislature also finds that the lack of disclosure regarding nonmedical service refusals by health care facilities can lead to delays in treatment, emotional trauma, and increased health risks, thereby compromising public trust in the health care system. Furthermore, the State has a compelling interest in protecting public health and ensuring that patients receive timely, accurate, and accessible information about the services that health care facilities are willing or unwilling to provide. Other states, such as Colorado, have successfully enacted legislation requiring health care facilities to disclose up‑front the medical services they refuse to provide for nonmedical reasons, thus promoting transparency to patients.

Accordingly, the purpose of this Act is to:

(1) Require the department of health to develop a service availability form to be completed by covered entities to convey to patients and the public certain health care services unavailable at the facility and publish and maintain on its website a list of covered entities and the service availability form for each covered entity;

(2) Require the department of health to adopt rules to implement the requirements of this Act, including a process to receive and investigate complaints and assess fines against covered entities in violation; and

(3) Require each covered entity to provide patients with the current service availability form as part of the informed consent process before initiating a health care service and maintain a record of the patient's receipt of the form.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

patients' right to know act

§ -1 Definitions. As used in this chapter:

"Covered entity" means any general hospital, community clinic, freestanding emergency department, maternity hospital, or rehabilitation hospital. "Covered entity" does not include a health care professional.

"Denial of care" means any refusal by a covered entity to provide a health care service, or to provide a referral for a health care service, for nonmedical reasons. "Denial of care" includes the following practices, whether based on formal or informal policies or practices, that are not based on generally accepted standards of care:

(1) Selective refusal to provide a health care service to some, but not all, patients based on race, color, religion, age, sex, including gender identity or expression, sexual orientation, marital status, national origin, ancestry, disability, the covered entity's objections to a health care service, or for other nonmedical reasons; and

(2) A significant restriction on the availability of health care services.

"Department" means the department of health.

"Health care professional" means any person who is licensed, certified, registered, or otherwise authorized or permitted by law to administer health care or dispense medication in the ordinary course of business or practice of a profession.

"Health care service" means the provision of treatment, care, advice or guidance, or services or supplies, including:

(1) Preventative, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care;

(2) Counseling, assessment, procedures, or other services; or

(3) Selling, dispensing, or administering a prescription or nonprescription drug, device, or equipment.

"Nonmedical reasons" means nonclinical criteria, rules, or policies, whether written or unwritten, that restrict a health care professional providing health care services at a covered entity from providing types of care that a health care professional is authorized under law to provide and that the covered entity is licensed to provide.

"Service availability form" means the form created by the department pursuant to section -2 and completed by a covered entity.

§ -2 Department duties; service availability form; public access to information; complaint process; rules. (a) No later than December 1, 2026, the department shall:

(1) Identify health care services that are or may be subject to denial of care;

(2) Develop a clear and simple service availability form for the purpose of conveying to patients and to the public which of the identified health care services are and are not generally available or are subject to significant restriction at a covered entity. The service availability form shall include contact information for the covered entity in case a patient has specific questions about services available at the covered entity; and

(3) Review, and if appropriate, update the form at least biennially; provided that the department may develop different versions of the service availability form appropriate for different categories of covered entities.

(b) No later than February 1, 2027, the department shall:

(1) Publish and maintain on its website a current list of covered entities; and

(2) Provide the service availability form submitted by each covered entity for public access;

provided that the department may use various methods to display the information to enable patients to compare services available at covered entities.

(c) The department shall adopt rules pursuant to chapter 91 necessary to carry out the purposes of this chapter; provided that the rules shall include a process for receiving and investigating a complaint regarding a covered entity that fails to comply with this chapter and for assessing fines against any covered entity.

§ -3 Requirements for covered entities; non-compliance; penalty. (a) Each covered entity shall submit to the department:

(1) A completed service availability form no later than sixty days after the department issues or updates the service availability form; and

(2) An updated service availability form no later than thirty days after making a change to the availability of a health care service identified on the service availability form.

(b) No later than February 1, 2027, each covered entity shall adopt a policy to:

(1) Provide patients with its current service availability form as a part of the informed consent process before the initiation of the provision of any health care service to the patient;

(2) Maintain a record of the patient's receipt of the service availability form; and

(3) Encourage any health care professional who has privileges with the covered entity to provide the covered entity's service availability form to the patient or the patient's representative before any scheduled health care service at the covered entity.

(1) Provide the current service availability form to the patient or the patient's representative as part of the informed consent process before any provision of health care service for the patient is initiated; provided that if informed consent is impracticable due to an emergency or other circumstances, the covered entity may delay the provision of the service availability form, as appropriate, until the informed consent process is conducted;

(2) Maintain a record of the patient's or the patient's representative's receipt of the service availability form as part of the informed consent process; and

(3) Provide the current service availability form to any person upon request.

(d) Any covered entity that violates this section or any rule adopted by the department pursuant to this section shall be fined not more than $1,000 for each separate violation. Each day the violation continues shall constitute a separate offense. Any action taken to impose or collect the penalty provided for in this subsection shall be considered a civil action.

§ -4 Construction; limitation. (a) Nothing in this chapter shall be construed to:

(1) Permit or authorize denial of care or unlawful discrimination in the provision of any health care service; or

(2) Limit any cause of action under state or federal law, or limit any remedy in law or equity, against a covered entity, health care facility, or health care professional.

(b) Compliance with this chapter does not reduce or limit any potential liability for a covered entity, health care facility, or health care professional associated with denial of care or any violation of state or federal law.

§ -5 Severability. If any provision of this chapter or its application to any person or circumstances is held invalid, the invalidity does not affect other provisions or applications of this chapter that can be given effect without the invalid provision or application, and to this end the provisions of this chapter are severable."

SECTION 3. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1041
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII