Report Title:
Insurance; Direct Payment; Healthcare
Description:
Requires direct payment for the provision of pre-hospital ambulance treatment and transport services. Requires insurance entities contracting with the State to provide Medicaid coverage to enter into written contracts with a minimum of 50 percent of hospitals and providers in their coverage area. Effective July 1, 2020. (SB940 HD1)
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THE SENATE |
S.B. NO. |
940 |
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TWENTY-FIFTH LEGISLATURE, 2009 |
S.D. 1 |
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STATE OF HAWAII |
H.D. 1 |
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A BILL FOR AN ACT
RELATING TO INSURANCE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
SECTION 1. Currently, some insurers who do not have a contract with the State for provision of pre-hospital ambulance treatment and transport services send claim remittances or direct payments to patients. This practice burdens the patient with billing processing, burdens the State with the cost of collection services to collect payment from the patient, and creates an unnecessary situation of possible bad debt for the patient.
The primary purpose of this Act is to require insurers, mutual benefit societies, and health maintenance organizations to make direct payments to the State that funds the provision of pre-hospital ambulance treatment and transport services.
SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding to article 10A a new section to be appropriately designated and to read as follows:
"§431:10A‑ Direct payment for pre-hospital ambulance treatment and transport services. (a) Any accident and health or sickness insurer that offers coverage for pre-hospital ambulance treatment and transport services shall provide for direct payment for the provision of pre-hospital ambulance treatment and transport services. This subsection (a) shall not apply to any transaction between the provider of pre-hospital ambulance treatment and transport services and an insurer if the parties have entered into a contract providing for direct payment.
(b) For purposes of this section,
"Direct payment" means:
(1) A claim shall be filed on behalf of the enrollee for the provision of pre-hospital ambulance treatment and transport services with the insurer;
(2) The insurer shall pay for the provision of pre-hospital ambulance treatment and transport services within sixty days of receipt of a claim filed by the provider; and
(3) The provider shall not make a demand for payment from the enrollee for the provision of pre-hospital ambulance treatment and transport until payment has been received from the insurer. Thereafter, the provider may make a demand for payment from the enrollee for any unpaid portion of the services provided to the enrollee.
"Pre-hospital ambulance treatment and transport services" means ambulance treatment and transport services generated through requests to the State's 911 system."
SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding to article 1 a new section to be appropriately designated and to read as follows:
"§432:1‑ Direct payment for pre-hospital ambulance treatment and transport services. (a) A mutual benefit society that offers coverage for pre-hospital ambulance treatment and transport shall provide for the direct payment to the State for the provision of pre-hospital ambulance treatment and transport services. This subsection (a) shall not apply to any transaction between the provider of pre-hospital ambulance treatment and transport services and a mutual benefit society if the parties have entered into a contract providing for direct payment.
(b) For purposes of this section,
"Direct payment" means:
(1) A claim shall be filed on behalf of the enrollee for the provision of pre-hospital ambulance treatment and transport with the mutual benefit society;
(2) The mutual benefit society shall pay for the provision of pre-hospital ambulance treatment and transport services within sixty days of receipt of a claim filed by the provider; and
(3) The State shall not demand payment from the enrollee for the provision of pre-hospital ambulance treatment and transport provider until payment has been received from the mutual benefit society. Thereafter, the provider may make a demand for payment from the enrollee for any unpaid portion of the provider's fee.
"Pre-hospital ambulance treatment and transport services" means ambulance treatment and transport services generated through requests to the State's 911 system."
SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432D‑ Direct payment for pre-hospital ambulance treatment and transport services. (a) A health maintenance organization that offers coverage for pre-hospital ambulance treatment and transport shall provide for the direct payment for the provision of pre-hospital ambulance treatment and transport services. This subsection (a) shall not apply to any transaction between the provider of pre-hospital ambulance treatment and transport services and a health maintenance organization if the parties have entered into a contract providing for direct payment.
(b) For purposes of this section,
"Direct payment" means:
(1) A claim shall be filed on behalf of the enrollee for the provision of pre-hospital ambulance treatment and transport with the health maintenance organization;
(2) The health maintenance organization shall pay for the provision of pre-hospital ambulance treatment and transport services within sixty days of receipt of a claim filed by the provider; and
(3) The provider shall not demand payment from the enrollee for the provision of pre-hospital ambulance treatment and transport provider until payment has been received from the health maintenance organization. Thereafter, the provider may make a demand for payment from the enrollee for any unpaid portion of the provider's fee.
"Pre-hospital ambulance treatment and transport services" means ambulance treatment and transport services generated through requests to the State's 911 system."
PART II
SECTION 5. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§346- Requirements for participating insurance entity. Within ninety days any insurance entity contracted by the State to provide medicaid coverage shall enter into written contracts with a minimum of fifty per cent of the hospitals and providers of healthcare services in the insurance entity's coverage areas. For purposes of this section, a letter of intent shall not be deemed a written contract."
PART III
SECTION 6. New statutory material is underscored.
SECTION 7. This Act shall take effect on July 1, 2020.