Report Title:

Insurance; Direct Payment; Healthcare

 

Description:

Requires direct payment to the State for provision of pre-hospital ambulance treatment and transport services.

 


HOUSE OF REPRESENTATIVES

H.B. NO.

1122

TWENTY-FIFTH LEGISLATURE, 2009

 

STATE OF HAWAII

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO INSURANCE.

 

 

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

 


     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 purpose of this Act is to require insurers, mutual benefit societies, and health maintenance organizations to make direct payments to the State that funds 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 to the State for provision of pre-hospital ambulance treatment and transport services.

     (b)  Subsection (a) shall not apply to any transaction between the State for provision of pre-hospital ambulance treatment and transport services and an insurer if the parties have entered into a contract providing for direct payment.

     (c)  For purposes of this section, "direct payment" means:

     (1)  The State shall file a claim on behalf of the enrollee for provision of pre-hospital ambulance treatment and transport services with the insurer;

     (2)  The insurer shall pay the State for provision of pre-hospital ambulance treatment and transport services directly within sixty days of receipt of a claim filed by the State; and

     (3) The State shall not make a demand for payment from the enrollee for provision of pre-hospital ambulance treatment and transport until payment has been received from the insurer.  Thereafter, the State may make a demand for payment from the enrollee for any unpaid portion of the services provided to the enrollee."

     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 direct payment to the State for provision of pre-hospital ambulance treatment and transport services.

     (b)  Subsection (a) shall not apply to any transaction between the State for provision 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.

     (c)  For purposes of this subdivision, "direct payment" means:

     (1)  The State shall file a claim on behalf of the enrollee for provision of pre-hospital ambulance treatment and transport with the mutual benefit society;

     (2)  The mutual benefit society shall pay the State for provision of pre-hospital ambulance treatment and transport services directly within sixty days of receipt of a claim filed by the State; and

     (3)  The State shall not demand payment from the enrollee for provision of pre-hospital ambulance treatment and transport provider until payment has been received from the mutual benefit society.  Thereafter, the State may make a may demand for payment from the enrollee for any unpaid portion of the provider's fee."

     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 direct payment to the State for provision of pre-hospital ambulance treatment and transport services.

     (b)  Subsection (a) shall not apply to any transaction between the State for provision 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.

     (c)  For purposes of this subdivision, "direct payment" means:

     (1)  The State shall file a claim on behalf of the enrollee for provision of pre-hospital ambulance treatment and transport with the health maintenance organization;

     (2)  The health maintenance organization shall pay the State for provision of pre-hospital ambulance treatment and transport services directly within sixty days of receipt of a claim filed by the State; and

     (3)  The State shall not demand payment from the enrollee for provision of pre-hospital ambulance treatment and transport provider until payment has been received from the health maintenance organization.  Thereafter, the State may make a demand for payment from the enrollee for any unpaid portion of the provider's fee."

     SECTION 5.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect upon its approval.

 

INTRODUCED BY:

_____________________________

 

 

BY REQUEST