SB 3133

THE SENATE
S.B. NO.
3133
THIRTY-THIRD LEGISLATURE, 2026
S.D. 2
STATE OF HAWAII
H.D. 3
A BILL FOR AN ACT
RELATING TO PREVENTIVE MEDICINE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
���� SECTION 1.� The legislature finds that recent changes to
the immunization recommendations provided by the Advisory Committee on
Immunization Practices of the United States Department of Health and Human
Services differ significantly from established medical standards and practice,
such as the immunization recommendations provided by the American Academy of
Pediatrics.� The legislature also finds
that insurance companies have only publicly committed to providing coverage of
vaccines that were part of the Advisory Committee's recommendations made before
September 2025 until the end of 2026.�
However, to protect the freedom of choice for the people of Hawaii to
comprehensively consider the full range of prevailing medical standards when it
comes to childhood immunization, there must be clarity regarding what their
insurance will cover.
���� 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.