Bill Text: HI SB324 | 2023 | Regular Session | Introduced
Bill Title: Relating To Health Care Cost-sharing Arrangements.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-01-25 - Referred to HHS, CPN. [SB324 Detail]
Download: Hawaii-2023-SB324-Introduced.html
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THE SENATE |
S.B. NO. |
324 |
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THIRTY-SECOND LEGISLATURE, 2023 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating
TO HEALTH CARE COST-SHARING ARRANGEMENTS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
"§431:3- Health care cost-sharing arrangement;
reporting requirements; disclosure. (a) A person, other than a producer, that offers,
operates, manages, or administers a health
care cost-sharing arrangement shall submit to the commissioner, by
October 1, 2024, and by March 1 of each year thereafter:
(1) The following information:
(A) The total number of individuals and
households that participated in the health care cost-sharing arrangement in the
State, in the immediately preceding calendar year;
(B) The total number of employer groups
that participated in the health care cost-sharing arrangement in the State in
the immediately preceding calendar year, specifying the total number of
participating individuals in the participating employer group;
(C) If the person offers a health care
cost-sharing arrangement in other states, the total number of participants in
this health care cost-sharing arrangement nationally;
(D) Any contracts the person has entered
into with providers in the State that provide health care services to health
care cost-sharing arrangement participants;
(E) The total number amount of fees, dues,
or other payments collected by the person in the immediately preceding calendar
year from individuals, employer groups, or others who participated in the health
care cost-sharing arrangement in the State, specifying their percentage of fees,
dues, or other payments retained by the person for administrative expenses;
(F) The total dollar amount of requests
for reimbursement of health care costs or services submitted in the State in
the immediately preceding calendar year by participants in the health care cost-sharing
arrangement or providers that provided health care services to health care cost-sharing
arrangement participants;
(G) The total dollar amount of requests
for reimbursement of health care costs or services that were submitted in the State
and were determined to qualify for reimbursement under the health care cost-sharing
arrangement in the immediately preceding calendar year;
(H) The total amount of payments made to
providers in the State in the immediately preceding calendar year for
healthcare services provided to, or received by, a health care cost-sharing
arrangement participant;
(I) The total amount of reimbursements
made to health care cost-sharing arrangement participants in the State in the
immediately preceding calendar year for healthcare services provided to, or
received by, a health care cost-sharing arrangement participant;
(J) The total number of requests for
reimbursement of health care costs or services submitted in the State in the
immediately preceding calendar year that were denied, expressed as a percentage
of total reimbursement requests submitted in that calendar year, and the total
number of reimbursement requests denials that were appealed;
(K) The total amount of health care
expenses submitted in the State by health care cost-sharing arrangement
participants or providers in the immediately preceding calendar year that
qualify for reimbursement pursuant to the health care cost-sharing arrangement
criteria but that, as of the end of the calendar year, have not been
reimbursed, excluding any amounts that the health care cost-sharing arrangement
participants incurring the health care costs are required to pay before
receiving reimbursement under the health care cost-sharing arrangement;
(L) The estimated number of health care
cost-sharing arrangement participants the person is anticipating in the State
in the next calendar year, specifying the estimated number of individuals,
households, employer groups, and employees;
(M) The specific counties in the State
in which the person:
(i) Offered a health care cost-sharing
arrangement in the immediately preceding calendar year; and
(ii) Intends to offer a health care cost-sharing
arrangement in the next calendar year;
(N) Other states in which the person
offers a health care cost-sharing arrangement;
(O) A list of any third parties, other
than a producer, that are associated with or assist the person in offering or
enrolling participants in the State in the health care cost-sharing arrangement,
copies of any training materials provided to a third party, and a detailed
accounting of any commissions or other fees or remuneration paid to a third
party in the immediately preceding calendar year for:
(i) Marketing, promoting, or enrolling
participants in a health care cost-sharing arrangement offered by the person in
the State; or
(ii) Operating, managing, or
administering a health care cost-sharing arrangement offered by the person in
the State;
(P) The total number of producers that
are associated with or assist the person in offering or enrolling participants
in the State in the health care cost-sharing arrangement; the total number of
participants enrolled in the health care cost-sharing arrangement through a producer;
copies of any training materials provided to a producer; and a detailed
accounting of any commissions or other fees or remuneration paid to a producer
in the immediately preceding calendar year for marketing, promoting, or
enrolling participants in a health care cost-sharing arrangement offered by the
person in the State;
(Q) Copies of any consumer-facing and
marketing materials used in the State in promotion of the health care cost-sharing
arrangement, including health care cost-sharing arrangement and benefit
descriptions and other materials that explain the health care cost-sharing
arrangement;
(R) The name, mailing address, e-mail
address, and telephone number of an individual serving as a contact for the
person in the State;
(S) A list of any parent companies,
subsidiaries, and other names that the person has operated under at any time
within the immediately preceding five calendar years; and
(T) An organizational chart for the
person and a list of the officers and directors of the person;
(2) A certification by an officer of the
person that, to the best of the person's good-faith knowledge and belief, the
information submitted is accurate and satisfies the requirements of this
subsection.
(b) If the person subject to the requirements of
subsection (a) fails to submit the required information or certification, the
submission shall be deemed incomplete.
The commissioner shall make a determination of completeness no later
than forty-five days after the submission.
If the commissioner has not informed the person of any deficiencies in
the submission within forty-five days after receiving the submission, the
submission shall be considered complete.
(c) If the commissioner determines that a person
has failed to comply with the requirements of subsection (a), the commissioner
shall:
(1) Notify the person that the
submission is incomplete and enumerate in the notification each deficiency
found in the person's submission; and
(2) Allow the person thirty days after
notice of the incomplete submission to remedy the deficiency found in the submission.
(d) If the person does not remedy the deficiency
within the thirty-day period, the commissioner may levy a fine not to exceed
five thousand dollars per day.
(e) If the person does not remedy the deficiency
or deficiencies within thirty days after the initial fine is levied, the
commissioner may issue a cease-and-desist order in accordance with section
431:2-203.
(f) The commissioner shall:
(1) On or before April 1, 2024, and on
or before each October 1 thereafter:
(A) Prepare a written report summarizing the information submitted by persons pursuant to subsection (a); and
(B) Post on the official website of the
insurance division, the report and accurate and evidence-based information
about the persons who submitted information pursuant to subsection (a),
including how consumers may file complaints; and
(2) Determine the market impact,
financial viability, and accuracy of advertising with regard to health care
cost-sharing arrangements in the State and submit a report of its findings and
recommendations, including any proposed legislation, to the legislature no
later than twenty days prior to the convening of each regular session.
(g) The commissioner may adopt rules as necessary
to implement this section.
(h) This section does not apply to any consumer payment arrangements identified by the commissioner by rule, including consumer payment plans offered directly by a provider to a patient or the party responsible for payment on behalf of the patient.
(i) As used in this section:
"Health care cost-sharing arrangement" means:
(1) A health care sharing ministry, as
defined in Title 26 United States Code section 5000A(d)(2)(B); or
(2) A medical cost-sharing community or
other arrangement or entity through which members of the community or
arrangement contribute money on a regular basis, at levels established by the
community or arrangement, that may be used to share, cover, or otherwise defray
the medical costs of members in the community or arrangement.
"Producer" means a person required to be licensed under the laws of the State to sell, solicit, or negotiate insurance."
SECTION 2. New statutory material is underscored.
SECTION 3. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Insurance; Health Care Cost-Sharing Arrangements; Insurance Commissioner; Disclosures
Description:
Requires persons who offer, operate, manage, or administer health care cost-sharing arrangements to make certain disclosures to the Insurance Commissioner. Establishes penalties for persons that fail to comply with the disclosure requirements. Requires the Insurance Commissioner to report to the Legislature.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
