Bill Text: HI HB2208 | 2010 | Regular Session | Introduced
Bill Title: Medicaid; Health Insurance; Payment
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2010-03-03 - (S) Referred to HMS, CPN. [HB2208 Detail]
Download: Hawaii-2010-HB2208-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
2208 |
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TWENTY-FIFTH LEGISLATURE, 2010 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO INSURANCE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Medicaid is a state program that provides health care to certain low-income individuals and families. The State sets the criteria for eligibility, determines the services that are available, and administers the program. As with all states, Hawaii's medicaid program is funded in large part by the federal government.
Medicaid operates in partnership with Hawaii's health care providers, as it does not employ health care practitioners, but rather, pays health care providers for services rendered to medicaid participants.
Prior to 1994, medicaid paid providers directly on a fee-for-services basis. In 1994, the Quest program was implemented to provide health care to many medicaid participants through a managed care approach. The State now contracts with health care insurance plans and pays each plan a capitated amount for each participant. The health plans in turn pay providers that deliver care to medicaid participants.
QuestEx was implemented to provide care on a managed care basis to the medicaid aged, blind, and disabled population. Since QuestEx began operating, health care providers have experienced many cases of delayed payments from health care plans contracted by the State. As a result of the delays, many providers have experienced severe financial difficulties that impact the providers' ability to deliver quality care.
The "clean claims" law found in section 431:13-108, Hawaii Revised Statutes, requires health plans to pay providers on a timely basis when uncontested claims are submitted. Specifically, the law requires payments to be made within thirty days for clean claims submitted in writing, and within fifteen days for clean claims submitted electronically.
However, the law contains an exemption for medicaid. As a result, health plans contracted by the State under medicaid may delay payments without penalty while health care providers are left to suffer.
The purpose of this Act is to repeal the exemption for health plans contracted by the State under medicaid from the clean claims law.
SECTION 2. Section 431:13-108, Hawaii Revised Statutes, is amended by amending the definition of "clean claim" in subsection (j) to read as follows:
""Clean claim" [means]:
(1) Means a claim in which the information in the possession of an entity adequately indicates that:
[(1)] (A) The
claim is for a covered health care service provided by an eligible health care
provider to a covered person under the contract;
[(2)] (B) The
claim has no material defect or impropriety;
[(3)] (C) There
is no dispute regarding the amount claimed; and
[(4)] (D) The
payer has no reason to believe that the claim was submitted fraudulently.
[The term does] (2) Does not include:
[(1)] (A) Claims
for payment of expenses incurred during a period of time when premiums were
delinquent;
[(2)] (B) Claims
that are submitted fraudulently or that are based upon material
misrepresentations; and
[(3) Medicaid or Medigap claims; and
(4)] (C) Claims
that require a coordination of benefits, subrogation, or preexisting condition
investigations, or that involve third-party liability."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect on July 1, 2010.
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INTRODUCED BY: |
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Report Title:
Medicaid; Health Insurance; Payment
Description:
Requires health insurers to promptly pay claims for services to medicaid recipients, by repealing the exemption for medicaid claims from the clean claims law.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
