REPORT TITLE:
Health Care Provider Payments


DESCRIPTION:
When a patient assigns reimbursement to the provider, requires
insurers, mutual benefit societies, and HMOs to pay the provider,
upon the provider's submission of the bill and notification of
assignment.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2227
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO PAYMENTS TO HEALTH CARE PROVIDERS.



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

 1      SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to article 10A to be appropriately
 
 3 designated and to read as follows:
 
 4      "431:10A-     Payment of claims to health care provider;
 
 5 penalty.  In cases where an insured patient receives services
 
 6 from a provider and the insured patient assigns to the provider
 
 7 the reimbursement from the insurer, the insurer, upon receipt of
 
 8 the provider's claim and notification of the assignment, shall
 
 9 pay the provider in a timely manner the same amount the insurer
 
10 would have reimbursed to the insured patient.  The insurer shall
 
11 be liable to the provider for payment regardless of whether or
 
12 not the insurer pays reimbursement to the patient.  In cases
 
13 where the insurer reimburses the patient, the insurer shall be
 
14 responsible for recovering the provider's payment from the
 
15 patient."
 
16      SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended
 
17 by adding a new section to article 1 to be appropriately
 
18 designated and to read as follows:
 
19      "432:1-     Payment of claims to health care provider;
 

 


 

Page 2                                                     2227
                                     H.B. NO.           
                                                        
                                                        


 1 penalty.  In cases where a member of an individual or group
 
 2 hospital or medical service plan receives services from a
 
 3 provider and the member assigns to the provider the reimbursement
 
 4 from the plan, the plan, upon receipt of the provider's claim and
 
 5 notification of the assignment, shall pay the provider in a
 
 6 timely manner the same amount the plan would have reimbursed to
 
 7 the member.  The plan shall be liable to the provider for payment
 
 8 regardless of whether or not the plan pays reimbursement to the
 
 9 member.  In cases where the plan reimburses the member, the plan
 
10 shall be responsible for recovering the provider's payment from
 
11 the member."
 
12      SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is
 
13 amended by adding a new section to be appropriately designated
 
14 and to read as follows:
 
15      "432D-     Payment of claims to health care provider;
 
16 penalty.  In cases where a subscriber of a health maintenance
 
17 organization contract, plan, or agreement receives services from
 
18 a provider and the subscriber assigns to the provider the
 
19 reimbursement from the health maintenance organization, the
 
20 health maintenance organization, upon receipt of the provider's
 
21 claim and notification of the assignment, shall pay the provider
 
22 in a timely manner the same amount the health maintenance
 

 
Page 3                                                     2227
                                     H.B. NO.           
                                                        
                                                        


 1 organization would have reimbursed to the subscriber.  The health
 
 2 maintenance organization shall be liable to the provider for
 
 3 payment regardless of whether or not the health maintenance
 
 4 organization pays reimbursement to the subscriber.  In cases
 
 5 where the health maintenance organization reimburses the
 
 6 subscriber, the health maintenance organization shall be
 
 7 responsible for recovering the provider's payment from the
 
 8 subscriber."
 
 9      SECTION 4.  New statutory material is underscored.
 
10      SECTION 5.  This Act shall take effect upon its approval.
 
11 
 
12                           INTRODUCED BY:  _______________________