|
HOUSE OF REPRESENTATIVES |
H.B. NO. |
2209 |
|
THIRTY-THIRD LEGISLATURE, 2026 |
|
|
|
STATE OF HAWAII |
|
|
|
|
|
|
|
|
||
|
|
||
A BILL FOR AN ACT
relating to health insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
The purpose of this Act is to increase access to substance use disorder treatment in the State by requiring health insurance carriers to honor a patient's written assignment of benefits to treatment providers. This ensures providers are paid directly, reduces administrative burdens, and protects patients from the dangers associated with receiving large reimbursement checks after discharge from care.
SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:
"§431:10A- Fair assignment of benefits for
substance use disorder services.
(a) A health insurance carrier
shall honor and accept a valid written assignment of benefits executed by a
covered person for the purpose of directing payment for covered substance use
disorder treatment services to the treating provider. Upon receipt of a valid assignment, the
health insurance carrier shall issue payment for covered services directly to
the substance use disorder treatment provider.
Payment made to the provider pursuant to this section shall discharge
the insurer's obligation to the extent of the payment made. Payment under this subsection shall be issued
within thirty days of receipt of a claim that meets the requirements of section
431:13-108.
(b) No health insurance policy, certificate,
agreement, or contract delivered, issued for delivery, or renewed in this State
shall contain any provision that prohibits, restricts, or renders void the
assignment of benefits to a substance use disorder treatment provider. Any clause or provision contained in a policy
subject to this subsection shall be unenforceable.
(c) The insurance commissioner may adopt rules
and take enforcement action necessary to implement this section.
(d) The insurance commissioner shall publish
annually, by electronic or online publication on the official website of the
insurance division, a summary of compliance trends, assignments of benefits
honored or denied, and enforcement actions taken.
(e) A substance use disorder treatment provider
who is denied payment by a health insurance carrier despite a valid assignment
may bring a civil action to compel compliance and may be awarded injunctive
relief, actual damages, interest, reasonable attorneys' fees, and costs.
(f) A violation of this section shall constitute
an unfair or deceptive act or practice under section 431:13-103.
(g) A health insurance carrier shall provide an
explanation of benefits to the assigned provider upon request, if the provider
presents a valid assignment of benefits, power of attorney, or authorization
executed by the covered person in compliance with the Health Insurance
Portability and Accountability Act of 1996.
A health insurance carrier's failure to provide an explanation of
benefits as required by this section shall be considered a violation of state
insurance law and shall be subject to enforcement action.
(h)
This
section shall apply to all fully insured health benefit plans governed by the
laws of the State, except self‑funded employer health benefit plans
regulated exclusively under the Employee Retirement Income Security Act of
1974, unless and to the extent permitted under federal law.
(i) For the purposes of this section:
"Assignment
of benefits" means a written direction by a covered person authorizing a
health insurance carrier to pay insurance benefits directly to a substance use
disorder treatment provider.
"Covered
person" means an individual who is insured under a health insurance plan
subject to the jurisdiction of the State.
"Health
insurance carrier" means any health insurer, health maintenance
organization, mutual benefit society, or other entity subject to state
insurance regulation that issues or administers health plans.
"Substance use disorder treatment provider" means any facility licensed by the office of health care assurance to provide residential or detoxification services for substance use disorders, or any program that provides partial hospitalization, intensive outpatient, or outpatient substance use disorder treatment services that are not subject to state licensure."
SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:
"§432:1- Fair assignment of benefits for
substance use disorder services.
(a) A health insurance carrier
shall honor and accept a valid written assignment of benefits executed by a
covered person for the purpose of directing payment for covered substance use
disorder treatment services to the treating provider. Upon receipt of a valid assignment, the
health insurance carrier shall issue payment for covered services directly to
the substance use disorder treatment provider.
Payment made to the provider pursuant to this section shall discharge
the insurer's obligation to the extent of the payment made. Payment under this subsection shall be issued within
thirty days of receipt of a claim that meets the requirements of section
431:13-108.
(b) No health insurance policy, certificate,
agreement, or contract delivered, issued for delivery, or renewed in this State
shall contain any provision that prohibits, restricts, or renders void the
assignment of benefits to a substance use disorder treatment provider. Any clause or provision contained in a policy
subject to this subsection shall be unenforceable.
(c) The insurance commissioner may adopt rules
and take enforcement action necessary to implement this section.
(d) The insurance commissioner shall publish
annually, by electronic or online publication on the official website of the
insurance division, a summary of compliance trends, assignments of benefits
honored or denied, and enforcement actions taken.
(e) A substance use disorder treatment provider
who is denied payment by a health insurance carrier despite a valid assignment
may bring a civil action to compel compliance and may be awarded injunctive
relief, actual damages, interest, reasonable attorneys' fees, and costs.
(f) A violation of this section shall constitute
an unfair or deceptive act or practice under section 431:13-103.
(g) A health insurance carrier shall provide an
explanation of benefits to the assigned provider upon request, if the provider
presents a valid assignment of benefits, power of attorney, or authorization
executed by the covered person in compliance with the Health Insurance
Portability and Accountability Act of 1996.
A health insurance carrier's failure to provide an explanation of
benefits as required by this section shall be considered a violation of state
insurance law and shall be subject to enforcement action.
(h)
This
section shall apply to all fully insured health benefit plans governed by the
laws of the State, except self‑funded employer health benefit plans
regulated exclusively under the Employee Retirement Income Security Act of
1974, unless and to the extent permitted under federal law.
(i) For the purposes of this section:
"Assignment
of benefits" means a written direction by a covered person authorizing a
health insurance carrier to pay insurance benefits directly to a substance use
disorder treatment provider.
"Covered
person" means an individual who is insured under a health insurance plan
subject to the jurisdiction of the State.
"Health
insurance carrier" means any health insurer, health maintenance
organization, mutual benefit society, or other entity subject to state
insurance regulation that issues or administers health plans.
"Substance use disorder treatment provider" means any facility licensed by the office of health care assurance to provide residential or detoxification services for substance use disorders, or any program that provides partial hospitalization, intensive outpatient, or outpatient substance use disorder treatment services that are not subject to state licensure."
SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:
"§432D-23
Required provisions and benefits. Notwithstanding any provision of law to the
contrary, each policy, contract, plan, or agreement issued in the State after
January 1, 1995, by health maintenance organizations pursuant to this chapter,
shall include benefits provided in sections 431:10-212, 431:10A-115,
431:10A-115.5, 431:10A-116, 431:10A‑116.2, 431:10A-116.5, 431:10A-116.6,
431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126,
431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [431:10A-134,]
431:10A- , and chapter 431M."
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect upon its approval.
|
INTRODUCED BY: |
_____________________________ |
|
|
|
Report Title:
Treatment Provider; Substance Use Disorder Services; Assignment of Benefits; Anti-Assignment Clause; Enforcement
Description:
Requires
health insurance carriers to honor a patient's written assignment of benefits
to a substance use disorder treatment provider.
Prohibits health insurance contracts from including anti-assignment
clauses that restrict or invalidate a patient's right to assign benefits. Authorizes the Insurance Commissioner to
adopt rules and take enforcement action to ensure compliance. Requires the Insurance Commissioner to
publish an annual summary. Allows
providers to bring civil actions to compel payment and obtain injunctive
relief, damages, interest, and attorneys' fees for violations. Deems violations to be unfair methods of
competition and unfair or deceptive acts or practices. Requires insurers to furnish an explanation
of benefits to the assigned provider upon request.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.