REPORT TITLE:
Payment Record Review; Limit


DESCRIPTION:
Prevents insurers, mutual benefit societies, and health
maintenance organizations from reviewing records of payments to
providers solely for accuracy and payment adjustments that are
more than 1 year old.  Allows review for any other purpose
including utilization review and statistical analysis.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           2597
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO REVIEW OF RECORDS OF 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-     Review of records of payment; one-year
 
 5 limitation.  No insurer subject to this article shall review,
 
 6 solely for the purpose of verification of accuracy of prior
 
 7 payments to health care providers and consequent adjustments to
 
 8 other payments to the provider whose records are reviewed,
 
 9 records of payments that were made more than one calendar year
 
10 before the initial date of review.  Nothing in this section shall
 
11 prevent an insurer from reviewing records of prior payments to
 
12 health care providers for any other purpose, including
 
13 utilization review and statistical analysis."
 
14      SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended
 
15 by adding a new section to article 1 to be appropriately
 
16 designated and to read as follows:
 
17      "432:1-     Review of records of payment; one-year
 
18 limitation.  No mutual benefit society, including any individual
 
19 or group hospital or medical service association, subject to this
 

 
Page 2                                                     
                                     S.B. NO.           2597
                                                        
                                                        

 
 1 chapter shall review, solely for the purpose of verification of
 
 2 accuracy of prior payments to health care providers and
 
 3 consequent adjustments to other payments to the provider whose
 
 4 records are reviewed, records of payments that were made more
 
 5 than one calendar year before the initial date of review.
 
 6 Nothing in this section shall prevent a mutual benefit society,
 
 7 including any individual or group hospital or medical service
 
 8 association, from reviewing records of prior payments to health
 
 9 care providers for any other purpose, including utilization
 
10 review and statistical analysis."
 
11      SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is
 
12 amended by adding a new section to be appropriately designated
 
13 and to read as follows:
 
14      "432D-     Review of records of payment; one-year
 
15 limitation.  No health maintenance organization subject to this
 
16 chapter shall review, solely for the purpose of verification of
 
17 accuracy of prior payments to health care providers and
 
18 consequent adjustments to other payments to the provider whose
 
19 records are reviewed, records of payments that were made more
 
20 than one calendar year before the initial date of review.
 
21 Nothing in this section shall prevent a health maintenance
 
22 organization from reviewing records of prior payments to health
 
23 care providers for any other purpose, including utilization
 

 
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                                     S.B. NO.           2597
                                                        
                                                        

 
 1 review and statistical analysis."
 
 2      SECTION 4.  New statutory material is underscored.
 
 3      SECTION 5.  This Act shall take effect upon its approval.
 
 4 
 
 5                           INTRODUCED BY:  _______________________