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SB967
THE SENATE
S.B. NO.
967
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
RELATING
TO HEALTH
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
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The legislature recognizes that the State has
a duty to protect and improve the health and environment of the people.
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The legislature finds that a number of state
residents suffer from depression.
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The
legislature also finds that according to an article published in Current
Neuropharmacology, the use of ketamine is a valid antidepressant option for the
treatment of treatment-resistant depression and has rapid antidepressant
effects.
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The
legislature also recognizes that according to ketamine clinics throughout the
State, intravenous ketamine therapy is typically conducted once every few weeks,
in a controlled environment with psychologist present.
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This form of treatment increases
neuroplasticity quicker than nasal spray (esketamine) treatment, which carries a
higher risk of addiction due to frequent dosing, typically twice per week, and
administration of those doses outside of a controlled environment.
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However, patients who attempt to obtain
intravenous ketamine therapy often cannot proceed, due to the high cost of the
treatment, which is approximately $700 per session.
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Mandating insurance coverage for intravenous
ketamine therapy would allow more patients to access the treatment.
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The
legislature notes that according to the department of human services, the use
of ketamine for treatment-resistant depression is an "off-label" use,
and that federal medicaid funds may not be spent for that used.
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Clinics have also noted that it will be
difficult to obtain approval from the United State Food and Drug Administration
for the use of ketamine for treatment-resistant depression, as long-established
generic treatments are already in the market, and approval from the
Administration typically requires financial backing from a pharmaceutical
company.
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Nevertheless,
the legislature believes that in light of Hawaii's mental health crisis,
insurance should cover intravenous ketamine therapy to treat treatment-resistant
depression.
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Accordingly,
the purpose of this Act is to:
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(1)
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Require medicaid and private insurance
to cover intravenous ketamine therapy to treat depression; and
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(2)
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Appropriate state moneys to the state medicaid
program to facilitate coverage of intravenous ketamine therapy.
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SECTION
2.
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Chapter 346, Hawaii Revised Statutes,
is amended by adding a new section to part I to be appropriately designated and
to read as follows:
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"
�346-
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Coverage for intravenous ketamine
therapy.
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Beginning on January 1, 2026, the
State's medicaid programs shall provide coverage for
per cent of the costs of intravenous ketamine
therapy to treat depression in qualifying patients, as determined by licensed
psychiatrists, medical doctors, or other medical professionals authorized to
prescribe ketamine.
"
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SECTION
3.
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Chapter 431, Hawaii Revised Statutes,
is amended by adding a new section to part I of article 10A to be appropriately
designated and to read as follows:
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"
�431:10A-
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Coverage for intravenous ketamine
therapy.
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Each individual or group policy of
accident and health or sickness insurance policy issued or renewed in this
State on or after January 1, 2026, shall provide to the policyholder and
individuals covered under the policy coverage for
per cent of the costs of intravenous ketamine
therapy to treat depression in qualifying patients, as determined by licensed
psychiatrists, medical doctors, or other medical professionals authorized to
prescribe ketamine.
"
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SECTION
4.
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Chapter 432, Hawaii Revised Statutes,
is amended by adding a new section to part VI of article I to be appropriately
designated and to read as follows:
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"
�432:1-
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Coverage for intravenous ketamine
therapy.
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Each individual or group hospital
or medical service plan contract issued or renewed in this State on or after
January 1, 2026, shall provide to the member and individuals covered under the
plan contract coverage for per cent of the costs
of intravenous ketamine therapy to treat depression in qualifying patients, as
determined by licensed psychiatrists, medical doctors, or other medical
professionals authorized to prescribe ketamine.
"
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SECTION
5
.
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Section
432D-23, Hawaii Revised Statutes, is amended to read as follows:
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"
�432D-23
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Required provisions and benefits.
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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."
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SECTION
6.
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There is appropriated out of the general
revenues of the State of Hawaii the sum of $
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or so much thereof as may be
necessary for fiscal year 2025-2026 and the same sum or so much thereof as may
be necessary for fiscal year 2026-2027 for costs arising from the coverage of
intravenous ketamine therapy required or authorized under section 2 of this
Act.
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The
sums
appropriated shall be expended
by the department of human services for the purposes of this Act.
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SECTION
7.
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Statutory material to be repealed is
bracketed and stricken.
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New statutory
material is underscored.
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SECTION
8.
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This Act shall take effect on July 1,
2025; provided that section 2 of this Act shall take effect upon approval of
the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services.
INTRODUCED BY:
_____________________________
Report Title:
Health
Insurance; Medicaid; Mandated Coverage; Ketamine Therapy; Appropriations
Description:
Requires
Medicaid and private insurance coverage for intravenous ketamine therapy to
treat depression.
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Appropriates moneys.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.