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HB820
HOUSE OF REPRESENTATIVES
H.B. NO.
820
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
relating
to health INSURANCE
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
�
The
legislature finds that over two hundred thousand residents live in rural areas
in the State, where unique challenges in health care access, affordability, and
outcomes are prevalent.
�
Rural residents
in the State often face a higher risk of chronic health issues, including
higher rates of diabetes and associated complications.
�
According to the federal Centers for Disease
Control and Prevention, rural residents are more likely to experience premature
mortality from heart disease, cancer, unintentional injuries, chronic lower
respiratory disease, and stroke.
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The legislature further finds that, despite
these obstacles, rural residents in the State play an essential role in the
State's economy, particularly in food and energy production.
�
However, managing diabetes within these
communities remains particularly challenging, with patients often facing
limited access to health care resources and critical diabetes management
tools.
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Approximately 108,600 adults, or
9.5 per cent of the adult population in the State live with diabetes, requiring
strict management of blood glucose levels, medication, and lifestyle choices to
prevent serious complications.
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The legislature also finds that continuous
glucose monitors (CGMs) offer life-changing benefits by providing real-time
data and trends on blood glucose levels, which surpass the limited information
from traditional blood glucose meters.
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CGMs help patients avoid dangerous blood sugar fluctuations and reduce
long-term complications, including the need for emergency care.
�
Studies show that individuals with diabetes
using CGMs experience fewer hypoglycemic episodes and lower A1C levels,
improving overall health outcomes.
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Given these benefits, the legislature finds
that it is in the State's best interest to expand access to continuous glucose
monitoring technology, particularly for residents in rural and high-risk
communities.
�
By doing so, the State aims
to reduce health disparities, increase health equity, and lower overall health
care costs.
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Accordingly, the purpose of this Act is to
require
all health insurers in the State, including medicaid managed care programs, to
cover continuous glucose monitors.
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SECTION
2
.
�
Section 431:10A-121, Hawaii Revised Statutes, is amended to read as
follows:
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"
�431:10A-121
�
Coverage for diabetes.
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[
Each
]
(a)
�
Except as provided in subsection (b), each
policy of accident and health or sickness
insurance providing coverage for health care, other than an accident-only,
specified disease, hospital indemnity, medicare supplement, long-term care, or
other limited benefit health insurance policy, that is issued or renewed in
this State, shall provide coverage for outpatient diabetes self-management
training, education, equipment, and supplies, if:
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(1)
�
The equipment, supplies, training, and
education are medically necessary; and
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(2)
�
The equipment, supplies, training, and
education are prescribed by a health care professional authorized to prescribe
.
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(b)
�
Each individual
or
group accident and health or
sickness
policy, contract, plan, or agreement
issued or renewed in th
e
State after December 31,
2025, shall provide coverage for
the cost of
continuous glucose monitors
and related supplies
for individuals covered under the policy, contract,
plan, or agreement and diagnosed with diabetes, including gestational diabetes,
regardless of whether they are treated with insulin; provided that:
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(1)
�
The continuous glucose
monitors
are
medically
necessary and
prescribed
by a health care professional authorized to prescribe
the
device; and
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(2)
�
The coverage:
���������
(A)
�
Shall
i
nclude
the cost of any necessary repairs or replacement parts for the continuous
glucose monitor
;
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(B)
�
Shall
be subject to a minimum benefit of
$ every
months; and
���������
(C)
�
May
be subject to copayment, deductible, and coinsurance provisions of the policy,
contract, plan, or agreement that are no less favorable than the copayment,
deductible, and coinsurance provisions for other medical services, equipment,
or supplies covered by the policy, contract, plan, or agreement;
provided
further that this subsection shall not apply to limited benefit health
insurance as provided in section 43l:10A�607.
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For
the purposes of this subsection, "c
ontinuous glucose
monitor" means a device designed to aid in diabetes management by
continuously measuring glucose levels through a small electronic sensor applied
to the skin
that
remains in place for a minimum of seven days, transmitting
glucose data in real-time or at set intervals to monitor and maintain safe
blood glucose levels.
"
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SECTION
3
.
�
Section 432:1-612, Hawaii Revised Statutes,
is amended to read as follows:
����
"
[
[
]
�432:1-612
[
]
]
�
Diabetes coverage.
�
[
All
]
Except as provided in subsection (b),
all
group
health care contracts under this chapter shall provide, to the extent provided
under section 431:10A-121, coverage for outpatient diabetes self-management
training, education, equipment, and supplies.
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(b)
�
Each hospital or medical service plan
contract
issued
or renewed in th
e
State
after December 31, 2025, shall provide coverage for
the
cost of
continuous
glucose monitors and related supplies
to the extent provided under
section 431:10A-121
.
����
For
the purposes of this subsection, "c
ontinuous glucose
monitor"
has the same meaning as defined in section
431:10A-121
.
"
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SECTION 4.
�
The benefit to be provided by health maintenance organizations
corresponding to the benefit provided under section 431:10A-
121
, Hawaii Revised
Statutes, as amended in section 2 of this Act, as contained in section 432D-23,
Hawaii Revised Statutes, shall take effect for all policies, contracts, plans,
or agreements issued or renewed in the State after December 31, 2025.
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SECTION 5.
�
The coverage required under sections 2, 3, and 4 of this Act shall apply
to all plans under medicaid managed care programs in the State.
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SECTION 6.
�
(a)
�
The department of human
services shall seek federal authorization and waivers as necessary to implement
this Act and to allow for full alignment with federal standards and
optimization of medicaid resources.
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(b)
�
The department of health and department of human services may accept and
expend funds from gifts, grants, and donations from individuals, private
organizations, foundations, or other governmental agencies to support the
expansion of continuous glucose monitor access; provided that no gift, grant,
or donation may be accepted if subject to conditions inconsistent with the laws
of this State.
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SECTION 7.
�
Statutory material to be repealed is bracketed and stricken.
�
New statutory material is underscored.
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SECTION 8.
�
This Act shall take effect on July 1, 2025; provided that sections 2, 3,
and 4 shall apply to all policies, contracts, plans, or agreements issued or
renewed in the State after December 31, 2025; provided further that section 6
shall take effect upon approval of the Hawaii medicaid state plan by the federal
Centers for Medicare and Medicaid Services.
INTRODUCED BY:
_____________________________
Report Title:
Department
of Human Services; Department of Health; Health Insurance; Medicaid; Mandated
Coverage; Diabetes; Equipment and Supplies; Continuous Glucose Monitors
Description:
Requires
all health insurers in the State, including Medicaid managed care programs, to
cover the cost of continuous glucose monitors and related supplies under
certain conditions.
�
Applies to insurance
policies, contracts, plans, or agreements issued or renewed in the State after
12/31/2025.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.