S.R. NO.













requesting the insurance commissioner to create a working group to study insurance recoupment.



     WHEREAS, Hawaii's health care system consists of a myriad of services that must be coordinated and integrated to ensure access to quality care at the appropriate level for all of Hawaii's residents; and


     WHEREAS, an individual often accesses different health care providers delivering different products and services and may transition from one level of health care to another over time; and


     WHEREAS, it is important to effectively manage patient transition to facilities providing the appropriate level of care to maintain the availability of services at all levels, more accurately address patient needs, and ensure efficient and cost effective service delivery; and


     WHEREAS, however, acute care hospitals are facing a financial crisis due to the manner in which Medicaid reimbursements are allocated; and


     WHEREAS, Medicaid reimbursements seldom cover the actual cost of provided services, resulting in fiscally weakened health care facilities and instability in the health care system as a whole; and


     WHEREAS, in the past, acute care hospitals were able to absorb Medicaid losses using payments from commercial and other payers to offset under-funded Medicaid reimbursements; and


     WHEREAS, as the cost of health care has increased, and significant developments in medical technology have required acute care hospitals to increase capital investments, even these payments are no longer enough to bridge the fiscal gap; and


     WHEREAS, the result for many of these hospitals is financial failure; now, therefore,


     BE IT RESOLVED by the Senate of the Twenty-seventh Legislature of the State of Hawaii, Regular Session of 2013, that the Insurance Commissioner is requested to form a working group to study insurance recoupment; and


     BE IT FURTHER RESOLVED that the insurance recoupment working group include the following members:


     (1)  Insurance Commissioner, who shall serve as chair;


     (2)  Director of Health, or the Director's designee;


     (3)  Director of Human Services, or the Director's designee;


     (4)  Representatives of the health care provider community;


     (5)  Representatives of health care professionals; and


     (6)  Consumer stakeholders; and


     BE IT FURTHER RESOLVED that the working group is requested to assess the problems of insurance recoupment, if any, study the impact of limiting the period allowed to initiate any recoupment or offset demand efforts, and review how other states mandate recoupment; and


     BE IT FURTHER RESOLVED that the working group is requested to report its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2014; and


     BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Insurance

Commissioner, Director of Health, and Director of Human Services.









Report Title: 

Insurance Recoupment; Insurance Commissioner; Working Group