HB83

SECTION 1. Chapter 386, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§386- Medical expenses; payment deadlines. (a) All medical expenses for which the insurer or self-insured employer is liable, upon receipt by the insurer or self-insured employer of all reports and documents incident to the services, shall be subject to the deadlines established by this section.

(b) Except as provided in subsection (c), each insurer or self-insured employer shall pay each written billing and report within sixty days after receipt by the insurer or self-insured employer. If payment is not made within this period, a penalty shall be assessed consisting of that portion of the billed sum then unreasonably unpaid increased by ten per cent, together with interest thereon at the rate of seven per cent per year retroactive to the date of receipt of the bill and report by the insurer or self-insured employer; provided that this penalty shall not apply if the injured employee was an employee of a government entity and the work injury related from that government employment. If the insurer or self-insured employer, within the sixty-day period, contests the reasonableness and necessity for incurring the fees, services, and expenses, payment shall be made within twenty days of the service of an order of the appellate board or director directing payment; provided that the penalty in this subsection shall not apply if:

(1) The insurer or self-insured employer pays the provider that portion of the charges that do not exceed the amount deemed reasonable pursuant to subsection (e) within sixty days of receipt of the report and itemized billing; and

(2) The insurer or self-insured employer prevails.

(c) If the provider contests the amount paid, the provider shall request a second review within ninety days of the service of the explanation of review. The request for a second review shall be submitted to the employer on a form prescribed by the director and shall include all of the following:

(1) The date of the explanation of review and the claim number or other unique identifying number provided on the explanation of review;

(2) The party or parties requesting the service;

(3) Any item and amount in dispute;

(4) The additional payment requested and the reason therefor; and

(5) Any additional information requested in the original explanation of review and any other information provided in support of the additional payment requested.

Within fourteen days of the request for second review, the employer shall respond with a final written determination on each of the items or amounts in dispute, including whether additional payment will be made.

If the provider contests the amount paid and the provider does not request a second review within ninety days of the service of the explanation of review, the bill shall be deemed withdrawn on the ninety-first day.

(d) If the insurer or self-insured employer denies all or a portion of the amount billed for any reason other than the amount to be paid pursuant to the fee schedules in effect on the date of service, the provider shall object to the denial within ninety days of the service of the explanation of review. If the provider objects to the denial within ninety days of the service of the explanation of review, the employer shall file a petition and a declaration of readiness to proceed with the appeals board within sixty days of service of the objection. If the employer prevails before the appeals board, the appeals board shall order the physician to reimburse the employer for the amount of the paid charges found to be unreasonable.

If the provider does not object to the denial within ninety days of the service of the explanation of review, the bill shall be deemed withdrawn on the ninety-first day. If the insurer or self-insured employer fails to file a petition and a declaration of readiness to proceed with the appeals board within sixty days of service of the objection, the denial shall be deemed withdrawn on the sixty-first day.

(e) If requested by the employee or the dependents of a deceased employee, within twenty days from the filing of an order of the appeals board directing payment, and where payment is not made within that period, that portion of the billed sum then unpaid shall be increased by ten per cent, together with interest thereon at the rate of seven per cent per year retroactive to the date of the filing of the order of the board directing payment.

(f) The insurer or self-insured employer shall notify in writing the provider of the services, the employee, or if represented, the employee's attorney, if the insurer or self-insured employer contests the reasonableness or necessity of incurring the expenses, and shall indicate the reasons therefor."

SECTION 2. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	83
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII