REPORT TITLE:
Direct Pmt. to Hlth. Facility


DESCRIPTION:
Requires insurers, mutual benefit societies, and health
maintenance organizations to pay health care facilities directly
regardless of their participatory status.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           511
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH CARE FACILITY PAYMENTS.



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-    Direct payment for health care services.  (a)
 
 5 An insurer, after receiving a claim for payment of benefits under
 
 6 this article, shall pay the indemnity or reimbursement directly
 
 7 to the health care facility that provided the services,
 
 8 regardless of the health care facility's participatory status
 
 9 with the insurer's plan.
 
10      (b)  If the insurer makes payment to the covered person, the
 
11 insurer shall remain liable for payment to the health care
 
12 facility.  This subsection does not prohibit the insurer from
 
13 recovering any amount mistakenly paid to the covered person."
 
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-    Direct payment for health care services.  (a)  A
 
18 mutual benefit society, after receiving a claim for payment of
 

 
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                                     S.B. NO.           511
                                                        
                                                        

 
 1 benefits under this chapter, shall pay the indemnity or
 
 2 reimbursement directly to the health care facility that provided
 
 3 the services, regardless of the health care facility's
 
 4 participatory status with the society's health care plan.
 
 5      (b)  If the society makes payment to the covered person, the
 
 6 society shall remain liable for payment to the health care
 
 7 facility.  This subsection does not prohibit the society from
 
 8 recovering any amount mistakenly paid to the covered person."
 
 9      SECTION 3.  Chapter 432D, Hawaii Revised Status, is amended
 
10 by adding a new section to be appropriately designated and to
 
11 read as follows:
 
12      "432D-    Direct payment for health care services.  (a)  A
 
13 health maintenance organization, after receiving a claim for
 
14 payment of benefits under this chapter, shall pay the indemnity
 
15 or reimbursement directly to the health care facility that
 
16 provided the health care services, regardless of the health care
 
17 facility's participatory status with the health maintenance
 
18 organization's plan.
 
19      (b)  If the health maintenance organization makes payment to
 
20 the covered person, the health maintenance organization shall
 
21 remain liable for payment to the health care facility.  This
 
22 subsection does not prohibit the health maintenance organization
 

 
 
 
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                                     S.B. NO.           511
                                                        
                                                        

 
 1 from recovering any amount mistakenly paid to the covered
 
 2 person."
 
 3      SECTION 4.  New statutory material is underscored.
 
 4      SECTION 5.  This Act shall take effect upon it approval.
 
 5 
 
 6                           INTRODUCED BY:  _______________________