SB 1245: Insurance Coverage; Pharmacists; Reimbursement; Health Insurers; Mutual Benefit Societies; Health Maintenance Organizations; Medicaid Plans

A BILL FOR AN ACT

RELATING TO PHARMACISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that there is currently a statewide physician shortage.  According to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78‑410.

     The legislature further finds that pharmacists can help bridge the gaps created by the physician shortage.  A pharmacist's skill set includes educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Additionally, patients are significantly less likely to be readmitted to the hospital when pharmacists provide clinical services after a hospital discharge.

     Accordingly, the purpose of this Act is to require private and public health plans issued in the State to recognize licensed pharmacists as participating providers and mandate payment or reimbursement for services provided by participating registered pharmacists within their scope of practice to the extent that the policy or plan provides coverage for the same service rendered by another health care provider.

     SECTION 2.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Include coverage for a service provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment to the extent that the policy provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service provided by a pharmacist within the scope of the pharmacist's practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the insurer to provide health care services to its insureds."

     SECTION 3.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group hospital or medical service plan contract delivered or issued for delivery in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Provide coverage for a service provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment to the extent that the plan contract provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service performed by a pharmacist within the scope of the pharmacist's practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the mutual benefit society to provide health care services to its subscribers or 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-     Services provided by participating registered pharmacists; coverage.  (a)  Each health maintenance organization policy, contract, plan, or agreement that is issued, amended, or renewed in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Provide coverage for a service provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment to the extent that the plan contract provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service provided by a pharmacist within the scope of the pharmacist's practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the health maintenance organization to provide health care services to its enrollees or subscribers."

     SECTION 5.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, pharmacists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule.  The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act."

     SECTION 6.  Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:

     "(g)  For the purposes of this section:

     "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

     "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, pharmacists licensed under chapter 461, and dentists licensed under chapter 448.

     "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

     "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

     "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities:  store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services."

     SECTION 7.  The department of human services shall apply to the United States Department of Health and Human Services for any amendment to the state medicaid plan or for any medicaid waiver necessary to implement sections 5 and 6 of this Act.

     SECTION 8.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 9.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 10.  This Act shall take effect upon its approval; provided that sections 5 and 6 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services; provided further that the amendments made to section 346-59.1, Hawaii Revised Statutes, by section 6 of this Act shall not be repealed when that section is reenacted on December 31, 2025, pursuant to section 8 of Act 107, Session Laws of Hawaii 2023.

Report Title:

Insurance Coverage; Pharmacists; Reimbursement; Health Insurers; Mutual Benefit Societies; Health Maintenance Organizations; Medicaid Plans

Description:

Beginning 7/1/2026, mandates reimbursement for services provided by participating registered pharmacists practicing within their scope of practice by private and public health plans in the State and requires the health plans to recognize pharmacists licensed in the State as participating providers.  (CD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO PHARMACISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that there is currently a statewide physician shortage.  According to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78‑410.

     The legislature further finds that pharmacists can help bridge the gaps created by the physician shortage.  A pharmacist's skill set includes educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Additionally, patients are significantly less likely to be readmitted to the hospital when pharmacists provide clinical services after a hospital discharge.

     Accordingly, the purpose of this Act is to require private and public health plans issued in the State to require coverage and payment or reimbursement for services provided by registered pharmacists within their scope of practice.

     SECTION 2.  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-     Services provided by participating registered pharmacists; coverage.  (a)  For each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in the State on or after January 1, 2026:

     (1)  Coverage for benefits for health care services provided by a registered pharmacist under this section shall not be denied if:

          (A)  The health care service was within the lawful scope of the registered pharmacist's license;

          (B)  The registered pharmacist is included in the insurer's network of participating providers; and

          (C)  A health care service is provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment and the policy provides coverage to the same extent as, and the insurer would have provided payment for, the same health care service provided by another health care provider; and

     (2)  The policy shall pay or reimburse a registered pharmacist or pharmacy for the cost of a service provided by a registered pharmacist within the scope of the registered pharmacist's practice.

     (b)  The participation of registered pharmacists in a policy of accident and health or sickness insurance that includes coverage for prescription drug benefits shall not satisfy the requirement that insurers include contracted registered pharmacists in the insurer's network of participating providers.

     (c)  The insurer shall not deny a registered pharmacist the ability to contract with the insurer if standard credentialing requirements are met, except for vertically integrated networks.

     (d)  For policies that include coverage for prescription drug benefits and that are issued or renewed on or after January 1, 2026, insurers that delegate credentialing agreements to health care facilities shall accept credentialing for registered pharmacists employed or contracted by those facilities.  Insurers shall reimburse health care facilities for covered services provided by a participating registered pharmacist within the registered pharmacist's scope of practice per negotiations with the facility.

     (e)  For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the insurer to provide health care services to its insureds."

     SECTION 3.  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-     Services provided by participating registered pharmacists; coverage.  (a)  For each individual or group hospital or medical service plan contract delivered or issued for delivery in the State on or after January 1, 2026:

     (1)  Coverage for benefits for health care services provided by a registered pharmacist under this section shall not be denied if:

          (A)  The health care service was within the lawful scope of the registered pharmacist's license;

          (B)  The registered pharmacist is included in the mutual benefit society's network of participating providers; and

          (C)  A health care service is provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment and the plan contract provides coverage to the same extent as, and the mutual benefit society would have provided payment for, the same health care service provided by another health care provider; and

     (2)  The plan contract shall pay or reimburse a registered pharmacist or pharmacy for the cost of a service provided by a registered pharmacist within the scope of the registered pharmacist's practice.

     (b)  The participation of registered pharmacists in the hospital or medical service plan contract that includes coverage for prescription drug benefits shall not satisfy the requirement that mutual benefit societies include contracted registered pharmacists in the mutual benefit society's network of participating providers.

     (c)  The mutual benefit society shall not deny a registered pharmacist the ability to contract with the mutual benefit society if standard credentialing requirements are met, except for vertically integrated networks.

     (d)  For plan contracts that include coverage for prescription drug benefits and that are issued or renewed on or after January 1, 2026, mutual benefit societies that delegate credentialing agreements to health care facilities shall accept credentialing for registered pharmacists employed or contracted by those facilities.  Mutual benefit societies shall reimburse health care facilities for covered services provided by a participating registered pharmacist within the registered pharmacist's scope of practice per negotiations with the facility.

     (e)  For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the mutual benefit society to provide health care services to its subscribers or 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-     Services provided by participating registered pharmacists; coverage.  (a)  For each health maintenance organization policy, contract, plan, or agreement that is issued, amended, or renewed in the State on or after January 1, 2026:

     (1)  Coverage for benefits for health care services provided by a registered pharmacist under this section shall not be denied if:

          (A)  The health care service was within the lawful scope of the registered pharmacist's license;

          (B)  The registered pharmacist is included in the health maintenance organization's network of participating providers; and

          (C)  A health care service is provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment and the policy, contract, plan, or agreement provides coverage to the same extent as, and the health maintenance organization would have provided payment for, the same health care service provided by another health care provider; and

     (2)  The policy, contract, plan, or agreement shall pay or reimburse a registered pharmacist or pharmacy for the cost of a service provided by a registered pharmacist within the scope of the registered pharmacist's practice.

     (b)  The participation of registered pharmacists in the policy, contract, plan, or agreement that includes coverage for prescription drug benefits shall not satisfy the requirement that health maintenance organizations include contracted registered pharmacists in the health maintenance organization's network of participating providers.

     (c)  The health maintenance organization shall not deny a registered pharmacist the ability to contract with the health maintenance organization if standard credentialing requirements are met, except for vertically integrated networks.

     (d)  For policies, contracts, plans, or agreements that include coverage for prescription drug benefits and that are issued or renewed on or after January 1, 2026, health maintenance organizations that delegate credentialing agreements to health care facilities shall accept credentialing for registered pharmacists employed or contracted by those facilities.  Health maintenance organizations shall reimburse health care facilities for covered services provided by a participating registered pharmacist within the registered pharmacist's scope of practice per negotiations with the facility.

     (e)  For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the health maintenance organization to provide health care services to its enrollees or subscribers."

     SECTION 5.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, pharmacists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule.  The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act."

     SECTION 6.  Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:

     "(g)  For the purposes of this section:

     "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

     "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, pharmacists licensed under chapter 461, and dentists licensed under chapter 448.

     "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

     "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

     "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities:  store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services."

     SECTION 7.  The department of human services shall apply to the United States Department of Health and Human Services for any amendment to the state medicaid plan or for any medicaid waiver necessary to implement sections 5 and 6 of this Act.

     SECTION 8.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 9.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 10.  This Act shall take effect on December 31, 2050; provided that sections 5 and 6 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services; provided further that the amendments made to section 346-59.1, Hawaii Revised Statutes, by section 6 of this Act shall not be repealed when that section is reenacted on December 31, 2025, pursuant to section 8 of Act 107, Session Laws of Hawaii 2023.

Report Title:

Insurance Coverage; Registered Pharmacists; Scope of Practice; Reimbursement; Health Insurers; Mutual Benefit Societies; Health Maintenance Organizations; Medicaid Plans

Description:

Beginning 1/1/2026, prohibits the denial of coverage and mandates reimbursement for services provided by registered pharmacists practicing within their scope of practice by private health plans in the State.  Clarifies that participation in a policy, contract, plan, or agreement with coverage for prescription drug benefits does not satisfy the requirement that contacted registered pharmacists be included in a network of participating providers.  Prohibits the denial of a registered pharmacist's ability to contract if standard credentialing requirements are met, with an exemption.  Specifies that if policies, contracts, plans, or agreements delegate credentialing to health care facilities, then the credentialing of registered pharmacists contracted or employed by those facilities shall be accepted.  Mandates reimbursement for services provided by registered pharmacists practicing within their scope of practice by public health plans upon approval of the Hawaii Medicaid State Plan by the Centers for Medicare and Medicaid Services.  Effective 12/31/2050.  (HD2)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO PHARMACISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that there is currently a statewide physician shortage.  According to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78‑410.

     The legislature further finds that pharmacists can help bridge the gaps created by the physician shortage.  A pharmacist's skill set includes educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Additionally, patients are significantly less likely to be readmitted to the hospital when pharmacists provide clinical services after a hospital discharge.

     Accordingly, the purpose of this Act is to require private and public health plans issued in the State to recognize licensed pharmacists as participating providers and mandate payment or reimbursement for services provided by participating registered pharmacists within their scope of practice to the extent that the policy or plan provides coverage for the same service rendered by another health care provider.

     SECTION 2.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Include coverage for a service provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the policy provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service performed by a pharmacist within the scope of their practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the insurer to provide health care services to its insureds."

     SECTION 3.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group hospital or medical service plan contract delivered or issued for delivery in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Provide coverage for a service provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the plan contract provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service performed by a pharmacist within the scope of their practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the mutual benefit society to provide health care services to its subscribers or 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-     Services provided by participating registered pharmacists; coverage.  (a)  Each health maintenance organization policy, contract, plan, or agreement that is issued, amended, or renewed in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Provide coverage for a service provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the plan contract provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service performed by a pharmacist within the scope of their practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the health maintenance organization to provide health care services to its enrollees or subscribers."

     SECTION 5.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, pharmacists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule.  The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act."

     SECTION 6.  Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:

     "(g)  For the purposes of this section:

     "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

     "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, pharmacists licensed under chapter 461, and dentists licensed under chapter 448.

     "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

     "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

     "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities:  store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services."

     SECTION 7.  The department of human services shall apply to the United States Department of Health and Human Services for any amendment to the state medicaid plan or for any medicaid waiver necessary to implement sections 5 and 6 of this Act.

     SECTION 8.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 9.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 10.  This Act shall take effect on December 31, 2050; provided that sections 5 and 6 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services; provided further that the amendments made to section 346-59.1, Hawaii Revised Statutes, by section 6 of this Act shall not be repealed when that section is reenacted on December 31, 2025, pursuant to section 8 of Act 107, Session Laws of Hawaii 2023.

Report Title:

Insurance Coverage; Pharmacists; Reimbursement; Health Insurers; Mutual Benefit Societies; Health Maintenance Organizations; Medicaid Plans

Description:

Beginning 7/1/2026, mandates reimbursement for services provided by participating registered pharmacists practicing within their scope of practice by private and public health plans in the State and requires the health plans to recognize pharmacists licensed in the State as participating providers.  Effective 12/31/2050.  (HD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO PHARMACISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that there is currently a statewide physician shortage.  According to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78‑410.

     The legislature further finds that pharmacists can help bridge the gaps created by the physician shortage.  A pharmacist's skill set includes educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Additionally, patients are significantly less likely to be readmitted to the hospital when pharmacists provide clinical services after a hospital discharge.

     Accordingly, the purpose of this Act is to require private and public health plans issued in the State to recognize licensed pharmacists as participating providers and mandate payment or reimbursement for services provided by participating registered pharmacists within their scope of practice to the extent that the policy or plan provides coverage for the same service rendered by another health care provider.

     SECTION 2.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in the State on or after July 1, 2026, shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Include coverage for a service provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the policy provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service performed by a pharmacist within the scope of their practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the insurer to provide health care services to its insureds."

     SECTION 3.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual and group hospital or medical service plan contract delivered or issued for delivery in the State on or after July 1, 2026, by a mutual benefit society shall:

     (1)  Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Provide coverage for a service provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the plan contract provides coverage for the same service rendered by another health care provider; and

     (3)  Pay or reimburse a pharmacist or pharmacy for the cost of a service performed by a pharmacist within the scope of their practice.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the mutual benefit society to provide health care services to its members."

     SECTION 4.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, pharmacists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule.  The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act."

     SECTION 5.  Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:

     "(g)  For the purposes of this section:

     "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

     "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, pharmacists licensed under chapter 461, and dentists licensed under chapter 448.

     "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

     "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

     "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities:  store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services."

     SECTION 6.  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 7.  The department of human services shall apply to the United States Department of Health and Human Services for any amendment to the state medicaid plan or for any medicaid waiver necessary to implement section 4 and section 5 of this Act.

     SECTION 8.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 9.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 10.  This Act shall take effect on December 31, 2050; provided that sections 4 and 5 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services; provided further that the amendments made to section 346-59.1, Hawaii Revised Statutes, by section 5 of this Act shall not be repealed when that section is reenacted on December 31, 2025, pursuant to section 8 of Act 107, Session Laws of Hawaii 2023.

Report Title:

Insurance Coverage; Pharmacists; Reimbursement

Description:

Beginning 7/1/2026, mandates reimbursement for services provided by participating registered pharmacists practicing within their scope of practice by private and public health plans in the State and requires the health plans to recognize pharmacists licensed in the State as participating providers.  Effective 12/31/2050.  (SD2)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO PHARMACISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that there is currently a statewide physician shortage.  According to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78‑410.

     The legislature further finds that pharmacists can help bridge the gaps created by the physician shortage.  A pharmacist's skill set includes educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Additionally, patients are three times more likely to stay out of the hospital when pharmacists provide clinical services after a hospital discharge.

     Accordingly, the purpose of this Act is to mandate reimbursement for services provided by pharmacists within their scope of practice by private and public health plans in the State.

     SECTION 2.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in this State after December 31, 2025, shall include coverage for care provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the insurer to provide health care services to its insureds."

     SECTION 3.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual and group hospital or medical service plan contract delivered or issued for delivery in this State after December 31, 2025, by a mutual benefit society shall include coverage for care provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the plan contract provides benefits for identical services rendered by another health care provider.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the mutual benefit society to provide health care services to its members."

     SECTION 4.  Section 346-53.64, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  Services eligible for prospective payment system reimbursement are those services that are furnished by a federally qualified health center or rural health clinic that are:

     (1)  Within the legal authority of a federally qualified health center to deliver, as defined in section 1905 of the Social Security Act;

     (2)  Actually provided by the federally qualified health center, either directly or under arrangements;

     (3)  Covered benefits under the medicaid program, as defined in section 4231 of the State Medicaid Manual and the Hawaii medicaid state plan;

     (4)  Provided to a recipient eligible for medicaid benefits;

     (5)  Delivered exclusively by health care professionals, including physicians, physician's assistants, nurse practitioners, pharmacists, nurse midwives, clinical social workers, clinical psychologists, and other persons acting within the lawful scope of their license or certificate to provide services;

     (6)  Provided at the federally qualified health center's practice site, a hospital emergency room, in an inpatient setting, at the patient's place of residence, including long term care facilities, or at another medical facility; and

     (7)  Within the scope of services provided by the State under its fee-for-service medicaid program and its medicaid managed care program, on and after August 1994, and as amended from time to time."

     SECTION 5.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, pharmacists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule.  The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act."

     SECTION 6.  Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:

     "(g)  For the purposes of this section:

     "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

     "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, pharmacists licensed under chapter 461, and dentists licensed under chapter 448.

     "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

     "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

     "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities:  store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services."

     SECTION 7.  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 8.  The department of human services shall apply to the United States Department of Health and Human Services for any amendment to the state medicaid plan or for any medicaid waiver necessary to implement section 4, section 5, and section 6 of this Act.  The department shall submit the medicaid state plan amendment no later than           .

     SECTION 9.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 10.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 11.  This Act shall take effect on December 31, 2050; provided that sections 4 through 6 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services; provided further that the amendments made to section 346-59.1, Hawaii Revised Statutes, by section 6 of this Act shall not be repealed when that section is reenacted on December 31, 2025, pursuant to section 8 of Act 107, Session Laws of Hawaii 2023.

Report Title:

Insurance Coverage; Pharmacists; Reimbursement

Description:

Beginning 1/1/2026, mandates reimbursement for services provided by participating registered pharmacists practicing within their scope of practice by private and public health plans in the State.  Effective 12/31/2050.  (SD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO PHARMACISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that there is currently a statewide physician shortage.  According to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78‑410.

     The legislature further finds that pharmacists can help bridge the gaps created by the physician shortage.  A pharmacist's skill set includes educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Additionally, patients are three times more likely to stay out of the hospital when pharmacists provide clinical services after a hospital discharge.

     Accordingly, the purpose of this Act is to mandate reimbursement for services provided by pharmacists within their scope of practice by private and public health plans in the State.

     SECTION 2.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in this State after December 31, 2025, shall recognize pharmacists licensed pursuant to chapter 461 as participating providers and shall include coverage for care provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the policy provides benefits for identical services rendered by another health care provider.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the insurer to provide health care services to its insureds."

     SECTION 3.  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-    Services provided by participating registered pharmacists; coverage.  (a)  Each individual and group hospital or medical service plan contract delivered or issued for delivery in this State after December 31, 2025, by a mutual benefit society shall recognize pharmacists licensed pursuant to chapter 461 as participating providers and shall include coverage for care provided by a participating registered pharmacist practicing within the scope of their license for purposes of health maintenance or treatment to the extent that the plan contract provides benefits for identical services rendered by another health care provider.

     (b)  For the purposes of this section, "participating registered pharmacist" means a pharmacist licensed pursuant to chapter 461 who has contracted with the mutual benefit society to provide health care services to its members."

     SECTION 4.  Section 346-53.64, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  Services eligible for prospective payment system reimbursement are those services that are furnished by a federally qualified health center or rural health clinic that are:

     (1)  Within the legal authority of a federally qualified health center to deliver, as defined in section 1905 of the Social Security Act;

     (2)  Actually provided by the federally qualified health center, either directly or under arrangements;

     (3)  Covered benefits under the medicaid program, as defined in section 4231 of the State Medicaid Manual and the Hawaii medicaid state plan;

     (4)  Provided to a recipient eligible for medicaid benefits;

     (5)  Delivered exclusively by health care professionals, including physicians, physician's assistants, nurse practitioners, pharmacists, nurse midwives, clinical social workers, clinical psychologists, and other persons acting within the lawful scope of their license or certificate to provide services;

     (6)  Provided at the federally qualified health center's practice site, a hospital emergency room, in an inpatient setting, at the patient's place of residence, including long term care facilities, or at another medical facility; and

     (7)  Within the scope of services provided by the State under its fee-for-service medicaid program and its medicaid managed care program, on and after August 1994, and as amended from time to time."

     SECTION 5.  Section 346-59, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, pharmacists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule.  The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount.

     The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule.  For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act."

     SECTION 6.  Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows:

     "(g)  For the purposes of this section:

     "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

     "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, pharmacists licensed under chapter 461, and dentists licensed under chapter 448.

     "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

     "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

     "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities:  store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services."

     SECTION 7.  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 8.  The department of human services shall apply to the United States Department of Health and Human Services for any amendment to the state Medicaid plan or for any Medicaid waiver necessary to implement section 4, section 5, and section 6 of this Act.  The office shall submit the Medicaid state plan amendment no later than           .

     SECTION 9.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 10.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 11.  This Act shall take effect upon its approval; provided that sections 4 through 6 shall take effect upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services.

Report Title:

Insurance Coverage; Pharmacists; Reimbursement

Description:

Beginning 1/1/2026, mandates reimbursement for services provided by participating registered pharmacists practicing within their scope of practice by private and public health plans in the State.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

CONFERENCE COMMITTEE REP. NO. 83

Honolulu, Hawaii

                 , 2025

RE:    S.B. No. 1245

       S.D. 2

       H.D. 2

       C.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir and Madam:

     Your Committee on Conference on the disagreeing vote of the Senate to the amendments proposed by the House of Representatives in S.B. No. 1245, S.D. 2, H.D. 2, entitled:

"A BILL FOR AN ACT RELATING TO PHARMACISTS,"

having met, and after full and free discussion, has agreed to recommend and does recommend to the respective Houses the final passage of this bill in an amended form.

     The purpose of this measure is to, beginning January 1, 2026:

     (1)  Prohibit the denial of coverage and mandate reimbursement for services provided by registered pharmacists practicing within their scope of practice by private health plans in the State;

     (2)  Clarify that participation in a policy, contract, plan, or agreement with coverage for prescription drug benefits does not satisfy the requirement that contacted registered pharmacists be included in a network of participating providers;

     (3)  Prohibit the denial of a registered pharmacist's ability to contract if standard credentialing requirements are met, with an exemption;

     (4)  Specify that if policies, contracts, plans, or agreements delegate credentialing to health care facilities, then the credentialing of registered pharmacists contracted or employed by those facilities shall be accepted; and

     (5)  Mandate reimbursement for services provided by registered pharmacists practicing within their scope of practice by public health plans upon approval of the Hawaii Medicaid State Plan by the Centers for Medicare and Medicaid Services.

     Your Committee on Conference finds that pharmacists are among the most trusted and accessible health care professionals, with about ninety percent of Americans living within five miles of a pharmacy, and pharmacists can provide high quality services, particularly related to the safe and effective use of medications.  Your Committee on Conference further finds that these pharmacist services are routinely provided in select in-patient, out-patient, and community or retail settings in the State, but because pharmacists are unable to be directly reimbursed by health plans for many of these services, building budget models that can sustainably pay for and expand these needed services are a challenge.  This measure improves reimbursement for services rendered by registered pharmacists under certain conditions to safely provide certain health care services cost-effectively and meet the health care needs of the State's residents.

     Your Committee on Conference has amended this measure by:

     (1)  Reverting to the language of the H.D. 1 version of this measure to:

          (A)  Specify that the provisions of this measure applicable to health insurers, mutual benefit societies, and health maintenance organizations apply to policies, contracts, plans, or agreements delivered or issued for delivery on or after July 1, 2026, rather than January 1, 2026; and

          (B)  Require policies, contracts, plans, or agreements by health insurers, mutual benefit societies, and health maintenance organizations to recognize pharmacists as participating providers;

     (2)  Deleting language that would have prohibited the denial of coverage for benefits for health care services provided by a registered pharmacist if certain conditions are met;

     (3)  Deleting language that would have provided that the participation of a registered pharmacist in a policy, contract, plan, or agreement that includes coverage for prescription drug benefits does not satisfy the requirements that health insurers, mutual benefit societies, and health maintenance organizations include contracted registered pharmacists in their networks of participating providers;

     (4)  Deleting language that would have prohibited insurers, mutual benefit societies, and health maintenance organizations from denying the ability for a registered pharmacist to contract with those entities if standard credentialing requirements are met, except for vertically integrated networks;

     (5)  Deleting language that would have specified that insurers, mutual benefit societies, and health maintenance organizations that delegate credentialing agreements to health care facilities shall accept credentialing of registered pharmacists employed or contracted by those facilities; and

     (6)  Amending section 1 to reflect its amended purposes;

     (7)  Making it effective upon its approval; and

     (8)  Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

     As affirmed by the record of votes of the managers of your Committee on Conference that is attached to this report, your Committee on Conference is in accord with the intent and purpose of S.B. No. 1245, S.D. 2, H.D. 2, as amended herein, and recommends that it pass Final Reading in the form attached hereto as S.B. No. 1245, S.D. 2, H.D. 2, C.D. 1.

Respectfully submitted on behalf of the managers:

STAND. COM. REP. NO.  2008

Honolulu, Hawaii

                , 2025

RE:   S.B. No. 1245

      S.D. 2

      H.D. 2

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

     Your Committee on Consumer Protection & Commerce, to which was referred S.B. No. 1245, S.D. 2, H.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO PHARMACISTS,"

begs leave to report as follows:

     The purpose of this measure is to mandate reimbursement for services provided by participating registered pharmacists within their scope of practice by private and public health plans in the State.

     Your Committee received testimony in support of this measure from the University of Hawai‘i at Hilo; Board of Pharmacy; Hawai‘i Pacific Health; Hawai‘i Primary Care Association; Grassroot Institute of Hawaii; Walgreen Co.; National Community Pharmacists Association; The Family Medicine Center; Molokaʻi Drugs, Inc.; Hawaiʻi Pharmacists Association; East Hawaii Independent Physicians Association dba Big Island Docs; Times Pharmacy; The Keto Prescription Clinic; Lihue Pharmacy; KTA Pharmacy; Hawai‘i Island Community Health Center; and numerous individuals.  Your Committee received comments on this measure from the Department of Commerce and Consumer Affairs and Hawaii Medical Service Association.

     Your Committee finds that the practice of pharmacy has evolved alongside significant changes in health care delivery.  Patient demand on the health care system is expected to increase significantly and outpace current provider supply over the next few years.  As a result, pharmacists now play a vital role in health care and are increasingly providing patient care services beyond the traditional prescription dispensing function.

     Your Committee further finds that in Hawaii, pharmacies are geographically dispersed throughout the community with extended hours of operation, making access to health care provided through pharmacies convenient for patients in each locality.  Patients have established relationships of trust with and recognize pharmacists as health care professionals.  This measure recognizes the importance of registered pharmacists within the State's health care system and ensures the proper compensation for their services.

     Your Committee has amended this measure by:

     (1)  Specifying that the provisions of this measure applicable to health insurers, mutual benefit societies, and health maintenance organizations apply to policies, contracts, plans, or agreements delivered or issued for delivery on or after January 1, 2026, rather than July 1, 2026;

     (2)  Deleting language that required policies, contracts, plans, or agreements by health insurers, mutual benefit societies, and health maintenance organizations to recognize pharmacists as participating providers;

     (3)  Specifying that coverage for benefits for health care services provided by a registered pharmacist shall not be denied if certain conditions are met;

     (4)  Clarifying that the participation of a registered pharmacist in a policy, contract, plan, or agreement that includes coverage for prescription drug benefits does not satisfy the requirements that health insurers, mutual benefit societies, and health maintenance organizations include contracted registered pharmacists in their networks of participating providers;

     (5)  Prohibiting insurers, mutual benefit societies, and health maintenance organizations from denying the ability for a registered pharmacist to contract with those entities if standard credentialing requirements are met, except for vertically integrated networks;

     (6)  Specifying that insurers, mutual benefit societies, and health maintenance organizations that delegate credentialing agreements to health care facilities shall accept credentialing of registered pharmacists employed or contracted by those facilities; and

     (7)  Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Consumer Protection & Commerce that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1245, S.D. 2, H.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1245, S.D. 2, H.D. 2.

Respectfully submitted on behalf of the members of the Committee on Consumer Protection & Commerce,

STAND. COM. REP. NO.  1424

Honolulu, Hawaii

                , 2025

RE:   S.B. No. 1245

      S.D. 2

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

     Your Committee on Health, to which was referred S.B. No. 1245, S.D. 2, entitled:

"A BILL FOR AN ACT RELATING TO PHARMACISTS,"

begs leave to report as follows:

     The purpose of this measure is to mandate reimbursement for services provided by pharmacists within their scope of practice by private and public health plans in the State.

     Your Committee received testimony in support of this measure from the University of Hawai‘i at Hilo; Board of Pharmacy; Hep Free Hawaii; Hawai‘i Pacific Health; Hawai‘i Primary Care Association; The Queen's Health Systems; National Community Pharmacists Association; Grassroot Institute of Hawaii; Walgreen Co.; Hawai‘i Pharmacists Association; American Pharmacists Association; The Family Medicine Center; Times Pharmacy; Moloka‘i Drugs, Inc.; and numerous individuals.

     Your Committee received comments on this measure from the Department of Commerce and Consumer Affairs; Office of the Auditor; Hawaii Medical Service Association; and Hawaii Association of Health Plans.

     Your Committee finds that pharmacists are geographically dispersed throughout the State's communities and can bridge the gaps created by the State's physician shortage by educating patients on how and when to check blood sugar, ways to avoid and manage hypoglycemia, how to take their medications correctly to avoid adverse effects, and various medication utilization techniques.  Your Committee further finds that the lack of access to pharmacist services disproportionally affects patient populations in the most isolated areas of the State.  Aligning the pharmacist reimbursement practices with the provision of their services, comparable to other health care providers, will allow pharmacies to remain open and enable local pharmacists to continue providing vital care to their patients.

     Your Committee has amended this measure by making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1245, S.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1245, S.D. 2, H.D. 1, and be referred to your Committee on Consumer Protection & Commerce.

Respectfully submitted on behalf of the members of the Committee on Health,

STAND. COM. REP. NO. 900

Honolulu, Hawaii

RE:    S.B. No. 1245

       S.D. 2

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

     Your Committee on Commerce and Consumer Protection, to which was referred S.B. No. 1245, S.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO PHARMACISTS,"

begs leave to report as follows:

     The purpose and intent of this measure is to mandate reimbursement for services provided by pharmacists within their scope of practice by private and public health plans issued in the State.

     Your Committee received testimony in support of this measure from the Board of Pharmacy; University of Hawaiʻi System; Family Medicine Center; Hawaiʻi Island Community Health Center; Times Pharmacy; The Queen's Health Systems; Lihue Pharmacy Group; Molokaʻi Drugs, Inc.; American Pharmacists Association; Hawaiʻi Pacific Health; Walgreen Co.; Hawaiʻi Pharmacists Association; KTA Pharmacy; Grassroot Institute of Hawaii; Keto Prescription Clinic; and fifteen individuals.

     Your Committee received comments on this measure from the Department of Human Services, Office of the Auditor, Hawaii Medical Service Association, and Hawaii Association of Health Plans.

Your Committee finds that there is a physician shortage in the State.  Pharmacists have made significant contributions to help bridge the gaps created by the physician shortage, especially in rural areas and neighbor islands.  Pharmacies are geographically dispersed throughout the community with extended hours of operation, making access to health care convenient for patients in each locality.  In response to the COVID-19 pandemic, pharmacists aided in ordering and administering COVID-19 tests and vaccines in pharmacies across the State, safely expanding patient access to care.  However, despite their extensive training and vital contributions, pharmacists face barriers to reimbursement from health insurance for the care that they provide.  Without provider status, many pharmacists will continue to remain uncompensated for their services, limiting their ability to expand their practice and better support community health initiatives.  This measure aligns Hawaii with a number of other states to help ensure pharmacists are able to continue to serve their communities and provide access to quality health care across the State.

     Your Committee has amended this measure by:

     (1)  Reinserting language from the original version of this measure to require private and public health plans to recognize pharmacists licensed pursuant to chapter 461, Hawaii Revised Statutes, as participating providers for any plan delivered or issued for delivery in the State on or after July 1, 2026;

     (2)  Inserting language to require payment or reimbursement to a pharmacist or pharmacy for the cost of a service performed within their scope of practice;

     (3)  Removing language that would have inappropriately added pharmacists to section 346-53.64, Hawaii Revised Statutes, relating to Federally Qualified Health Centers;

     (4)  Deleting language that would have required the Department of Human Services to submit any needed state Medicaid plan amendments and waivers to the United States Department of Health and Human Services for federal approval by an unspecified date;

     (5)  Amending section 1 to reflect its amended purpose; and

     (6)  Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

     As affirmed by the record of votes of the members of your Committee on Commerce and Consumer Protection that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1245, S.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1245, S.D. 2.

Respectfully submitted on behalf of the members of the Committee on Commerce and Consumer Protection,

STAND. COM. REP. NO. 269

Honolulu, Hawaii

RE:    S.B. No. 1245

       S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

     Your Committee on Health and Human Services, to which was referred S.B. No. 1245 entitled:

"A BILL FOR AN ACT RELATING TO PHARMACISTS,"

begs leave to report as follows:

     The purpose and intent of this measure is to, beginning January 1, 2026, mandate reimbursement for services provided by pharmacists practicing within their scope of practice by private and public health plans in the State.

     Your Committee received testimony in support of this measure from the University of Hawaiʻi System; Indivisible Hawaii; Hawai‘i Primary Care Association; Hawai‘i Pacific Health; American Pharmacists Association; American Society of Health-System Pharmacists; KTA Super Stores; Grassroot Institute of Hawaii, Inc.; Democratic Party of Hawai‘i; KTA Pharmacy; Walgreens Co.; Molokaʻi Drugs, Inc.; Big Island Docs; Hawaiʻi Pharmacists Association; Times Pharmacy; National Community Pharmacists Association; and thirty-two individuals.

     Your Committee received comments on this measure from the Department of Human Services, Insurance Division of the Department of Commerce and Consumer Affairs, Office of the Auditor, The Queen's Health System, Kaiser Permanente Hawaii, Hawaii Medical Service Association, Hawaii Association of Health Plans, and Keto Prescription Clinic.

     Your Committee finds that according to the federal Health Resources and Services Administration, each county in the State contains a region that is a medically underserved area, as defined by the Public Health Service Act of 1944, Public Law 78-410.  Your Committee further finds that pharmacists can help bridge the gaps created by the physician shortage.  This measure provides greater access to health care services delivered by pharmacists, particularly for the State's neighbor island patients.

     Your Committee notes the concerns raised in testimony regarding the lack of clarity in the eligibility criteria for pharmacists to receive reimbursements from insurers.  Specifically, the proposed language in this measure can be misconstrued as requiring the insurers to pay all licensed pharmacists, including those who do not have a contract with the insurer.

     Accordingly, your Committee has amended this measure by:

     (1)  Deleting language that would have required each individual or group policy of accident and health or sickness insurance delivered or issued for delivery in this State after December 31, 2025, to recognize pharmacists licensed pursuant to chapter 461 as participating providers;

     (2)  Inserting an effective date of December 31, 2050, to encourage further discussion; and

     (3)  Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

     As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1245, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1245, S.D. 1, and be referred to your Committee on Commerce and Consumer Protection.

Respectfully submitted on behalf of the members of the Committee on Health and Human Services,