SB 1411: Medicaid; Third-Party Liability; Medical Assistance Program Claims
- Session Year: 2025-2026
- House: Senate
- Latest Version Date: 2025-04-01
Current Status:
In Progress
(2025-05-15: Act 059, on 05/15/2025 (Gov. Msg. No. 1159).)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Final Decking
Enacted
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022. (HD2)
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022. Effective 7/1/3000. (HD1)
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022. Effective 7/1/2050. (SD2)
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act, 2022. (SD1)
Amends third party liability provisions for medical assistance program claims for payment as required under the Consolidated Appropriations Act, 2022.
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THE SENATE |
S.B. NO. |
1411 |
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THIRTY-THIRD LEGISLATURE, 2025 |
S.D. 2 |
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STATE OF HAWAII |
H.D. 2 |
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A BILL FOR AN ACT
RELATING TO MEDICAID THIRD PARTY LIABILITY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
Accordingly, the purpose of this Act is to amend state law to comply with the federal requirements amended pursuant to section 202 of division P of the Consolidated Appropriations Act, 2022.
SECTION 2. Section 431L-2.5, Hawaii Revised Statutes, is amended to read as follows:
"§431L-2.5 Insurer requirements. Any health insurer as identified in section 431L-1 shall:
(1) Provide upon the request of the State,
information for all of its members to determine during what period the
individual or [the] individual's spouse or dependents may be or may have
been covered by a health insurer and the nature of the coverage that is or was
provided by the health insurer, including the name, address, and identifying
number of the plan in a manner prescribed by the State;
(2) Beginning in 2014, provide to an independent, third party entity, no more than quarterly, a report listing its members. The third party entity shall match this report with one provided by the department of human services and provide the department of human services with third party liability information for medical assistance recipients. The department of human services shall determine the minimum data required to ensure the validity of matches, which may include name, date of birth, and social security number, as available. The information provided by the health insurers to the third party entity shall not be used for any purpose other than that specified in this chapter. The department of human services shall provide for representation by private health insurers in evaluating the qualifications of potential third party entities and determining the minimum data fields for matching;
(3) Accept the State's right of recovery and the assignment to the State of any right of an individual or other entity to payment from the party for a health care item or service for which payment has been made for medical assistance under title 42 United States Code section 1396a (section 1902 of the Social Security Act);
(4) Respond to any inquiry by the State within
sixty calendar days regarding a payment of a claim for [payment
for] any health care item or service that is submitted [not] no
later than three years after the date of the provision of the health care item
or service; [and]
(5) Agree not to deny a claim submitted by
the State solely on the basis of the date of submission of the claim[,];
the type or format of the claim form[, or]; a failure to present
proper documentation at the point-of-sale that is the basis of the claim[,];
or, in the case of a responsible third party, a failure to obtain a prior
authorization for the item or service for which the claim is being submitted
if:
(A) The claim is submitted by the State within the three-year period beginning on the date on which the health care item or service was furnished; and
(B) Any action by the State to enforce its
rights with respect to the claim is commenced within six years of the State's
submission of the
claim[.]; and
(6) Agree, when a responsible third party requires prior authorization for an item or a service furnished to an individual eligible to receive medical assistance under the state medical assistance program, to accept authorization provided by the state medical assistance program that the item or service is covered under the state medical assistance program for that individual, as if the authorization were the prior authorization made by the third party for the item or service."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect upon its approval.
Report Title:
Medicaid; Third-Party Liability; Medical Assistance Program Claims
Description:
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022. (HD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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THE SENATE |
S.B. NO. |
1411 |
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THIRTY-THIRD LEGISLATURE, 2025 |
S.D. 2 |
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STATE OF HAWAII |
H.D. 1 |
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A BILL FOR AN ACT
RELATING TO MEDICAID THIRD PARTY LIABILITY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
Accordingly, the purpose of this Act is to amend state law to comply with the federal requirements amended pursuant to section 202 of the Consolidated Appropriations Act, 2022.
SECTION 2. Section 431L-2.5, Hawaii Revised Statutes, is amended to read as follows:
"§431L-2.5 Insurer requirements. Any health insurer as identified in section 431L-1 shall:
(1) Provide upon the request of the State, information for all of its members to determine during what period the individual or the individual's spouse or dependents may be or may have been covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan in a manner prescribed by the State;
(2) Beginning in 2014, provide to an independent, third party entity, no more than quarterly, a report listing its members. The third party entity shall match this report with one provided by the department of human services and provide the department of human services with third party liability information for medical assistance recipients. The department of human services shall determine the minimum data required to ensure the validity of matches, which may include name, date of birth, and social security number, as available. The information provided by the health insurers to the third party entity shall not be used for any purpose other than that specified in this chapter. The department of human services shall provide for representation by private health insurers in evaluating the qualifications of potential third party entities and determining the minimum data fields for matching;
(3) Accept the State's right of recovery and the assignment to the State of any right of an individual or other entity to payment from the party for a health care item or service for which payment has been made for medical assistance under title 42 United States Code section 1396a (section 1902 of the Social Security Act);
(4) Respond to any inquiry by the State within
sixty calendar days regarding a payment of a claim for [payment
for] any health care item or service that is submitted [not] no
later than three years after the date of the provision of the health care item
or service; [and]
(5) Agree not to deny a claim submitted by
the State solely on the basis of the date of submission of the claim[,];
the type or format of the claim form[, or]; a failure to present
proper documentation at the point-of-sale that is the basis of the claim[,];
or, in the case of a responsible third party, a failure to obtain a prior
authorization for the item or service for which the claim is being submitted
if:
(A) The claim is submitted by the State within the three-year period beginning on the date on which the health care item or service was furnished; and
(B) Any action by the State to enforce its
rights with respect to the claim is commenced within six years of the State's
submission of the
claim[.]; and
(6) Agree, when a responsible third party requires prior authorization for an item or service furnished to an individual eligible to receive medical assistance under the state medical assistance program, to accept authorization provided by the state medical assistance program that the item or service is covered under the state medical assistance program for that individual, as if the authorization were the prior authorization made by the third party for the item or service."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect on July 1, 3000.
Report Title:
Medicaid; Third-Party Liability; Medical Assistance Program Claims
Description:
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022. Effective 7/1/3000. (HD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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THE SENATE |
S.B. NO. |
1411 |
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THIRTY-THIRD LEGISLATURE, 2025 |
S.D. 2 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO MEDICAID THIRD PARTY LIABILITY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
Accordingly, the purpose of this Act is to amend state law to comply with the federal requirements amended pursuant to section 202 of the Consolidated Appropriations Act, 2022.
SECTION 2. Section 431L-2.5, Hawaii Revised Statutes, is amended to read as follows:
"§431L-2.5 Insurer requirements. Any health insurer as identified in section 431L-1 shall:
(1) Provide upon the request of the State, information for all of its members to determine during what period the individual or the individual's spouse or dependents may be or may have been covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan in a manner prescribed by the State;
(2) Beginning in 2014, provide to an
independent, third party entity, [no] not more than quarterly, a
report listing its members. The third
party entity shall match this report with one provided by the department of
human services and provide the department of human services with third party
liability information for medical assistance recipients. The department of human services shall
determine the minimum data required to ensure the validity of matches, which
may include name, date of birth, and social security number, as available. The information provided by the health
insurers to the third party entity shall not be used for any purpose other than
that specified in this chapter. The
department of human services shall provide for representation by private health
insurers in evaluating the qualifications of potential third party entities and
determining the minimum data fields for matching;
(3) Accept the State's right of recovery and the assignment to the State of any right of an individual or other entity to payment from the party for a health care item or service for which payment has been made for medical assistance under title 42 United States Code section 1396a (section 1902 of the Social Security Act);
(4) Respond to any inquiry by the State within
sixty calendar days regarding a health care claim for [payment
for] any health care item or service that is submitted [not] no
later than three years after the date of the provision of the health care item
or service; [and]
(5) Agree not to deny a claim submitted by
the State solely on the basis of the date of submission of the claim[,];
the type or format of the claim form[, or]; a failure to present
proper documentation at the point-of-sale that is the basis of the claim[,];
or, in the case of a responsible third party, a failure to obtain a prior
authorization for the item or service for which the claim is being submitted
if:
(A) The claim is submitted by the State within the three-year period beginning on the date on which the health care item or service was furnished; and
(B) Any action by the State to enforce its
rights with respect to the claim is commenced within six years of the State's
submission of the
claim[.]; and
(6) Agree, when a responsible third party requires prior authorization for an item or service furnished to an individual eligible to receive medical assistance under the state medical assistance program, to accept authorization provided by the state medical assistance program that the item or service is covered under the state medical assistance program for that individual, as if the authorization were the prior authorization made by the third party for the item or service."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect on July 1, 2050.
Report Title:
Medicaid; Third-Party Liability
Description:
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022. Effective 7/1/2050. (SD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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THE SENATE |
S.B. NO. |
1411 |
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THIRTY-THIRD LEGISLATURE, 2025 |
S.D. 1 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO MEDICAID THIRD PARTY LIABILITY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
Accordingly, the purpose of this Act is to amend state law to comply with the federal requirements amended pursuant to section 202 of the Consolidated Appropriations Act, 2022.
SECTION 2. Section 431L-2.5, Hawaii Revised Statutes, is amended to read as follows:
"§431L-2.5 Insurer requirements. Any health insurer as identified in section 431L-1 shall:
(1) Provide upon the request of the State, information for all of its members to determine during what period the individual or the individual's spouse or dependents may be or may have been covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan in a manner prescribed by the State;
(2) Beginning in 2014, provide to an
independent, third party entity, [no] not more than quarterly, a
report listing its members. The third
party entity shall match this report with one provided by the department of
human services and provide the department of human services with third party
liability information for medical assistance recipients. The department of human services shall
determine the minimum data required to ensure the validity of matches, which
may include name, date of birth, and social security number, as available. The information provided by the health insurers
to the third party entity shall not be used for any purpose other than that
specified in this chapter. The
department of human services shall provide for representation by private health
insurers in evaluating the qualifications of potential third party entities and
determining the minimum data fields for matching;
(3) Accept the State's right of recovery and the assignment to the State of any right of an individual or other entity to payment from the party for a health care item or service for which payment has been made for medical assistance under title 42 United States Code section 1396a (section 1902 of the Social Security Act);
(4) Respond to any inquiry by the State within
sixty calendar days regarding a health care claim for [payment
for] any health care item or service that is submitted [not] no
later than three years after the date of the provision of the health care item
or service; [and]
(5) Agree not to deny a claim submitted by
the State solely on the basis of the date of submission of the claim[,];
the type or format of the claim form[, or]; a failure to present
proper documentation at the point-of-sale that is the basis of the claim[,];
or, in the case of a responsible third party, a failure to obtain a prior
authorization for the item or service for which the claim is being submitted
if:
(A) The claim is submitted by the State within the three-year period beginning on the date on which the health care item or service was furnished; and
(B) Any action by the State to enforce its
rights with respect to the claim is commenced within six years of the State's
submission of the
claim[.]; and
(6) Agree, when a responsible third party requires prior authorization for an item or service furnished to an individual eligible to receive medical assistance under the state medical assistance program, to accept authorization provided by the state medical assistance program that the item or service is covered under the state medical assistance program for that individual, as if the authorization were the prior authorization made by the third party for the item or service."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect upon its approval.
Report Title:
Medicaid; Third-Party Liability
Description:
Clarifies third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act, 2022. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
|
THE SENATE |
S.B. NO. |
1411 |
|
THIRTY-THIRD LEGISLATURE, 2025 |
|
|
|
STATE OF HAWAII |
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|
|
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A BILL FOR AN ACT
RELATING TO MEDICAID THIRD PARTY LIABILITY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
The purpose of this Act is to amend state law to comply with the amended federal requirements of section 202.
SECTION 2. Section 431L-2.5, Hawaii Revised Statutes, is amended to read as follows:
"§431L-2.5 Insurer requirements. Any health insurer as identified in section 431L-1 shall:
(1) Provide upon the request of the State, information for all of its members to determine during what period the individual or the individual's spouse or dependents may be or may have been covered by a health insurer and the nature of the coverage that is or was provided by the health insurer, including the name, address, and identifying number of the plan in a manner prescribed by the State;
(2) Beginning in 2014, provide to an independent, third party entity, no more than quarterly, a report listing its members. The third party entity shall match this report with one provided by the department of human services and provide the department of human services with third party liability information for medical assistance recipients. The department of human services shall determine the minimum data required to ensure the validity of matches, which may include name, date of birth, and social security number, as available. The information provided by the health insurers to the third party entity shall not be used for any purpose other than that specified in this chapter. The department of human services shall provide for representation by private health insurers in evaluating the qualifications of potential third party entities and determining the minimum data fields for matching;
(3) Accept the State's right of recovery and the assignment to the State of any right of an individual or other entity to payment from the party for a health care item or service for which payment has been made for medical assistance under title 42 United States Code section 1396a (section 1902 of the Social Security Act);
(4) Respond to any inquiry by the State within
sixty calendar days regarding a health care claim for [payment
for] any health care item or service that is submitted not later than three
years after the date of the provision of the health care item or service; [and]
(5) Agree not to deny a claim submitted by
the State solely on the basis of the date of submission of the claim, the type
or format of the claim form, [or] a failure to present proper
documentation at the point-of-sale that is the basis of the claim, or a
failure to obtain a prior authorization for the item or service for which the
claim is being submitted, in the case of a responsible third party, if:
(A) The claim is submitted by the State within the three-year period beginning on the date on which the health care item or service was furnished; and
(B) Any action by the State to enforce its
rights with respect to the claim is commenced within six years of the State's
submission of the
claim[.]; and
(6) Agree, when a responsible third party requires prior authorization for an item or service furnished to an individual eligible to receive medical assistance under the state medical assistance program, to accept authorization provided by the state medical assistance program that the item or service is covered under the state medical assistance program for that individual, as if the authorization were the prior authorization made by the third party for the item or service."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect upon its approval.
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INTRODUCED BY: |
_____________________________ |
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BY REQUEST |
Report Title:
Medicaid; Third Party Liability
Description:
Amends third party liability provisions for medical assistance program claims for payment as required under the Consolidated Appropriations Act, 2022.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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Date
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Status
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|---|---|
| May 15, 2025 | Act 059, on 05/15/2025 (Gov. Msg. No. 1159). |
| May 15, 2025 | Act 059, 05/15/2025 (Gov. Msg. No. 1159). |
| Apr 23, 2025 | Enrolled to Governor. |
| Apr 23, 2025 | Received notice of Final Reading (Sen. Com. No. 871). |
| Apr 23, 2025 | Passed Final Reading. Ayes, 25; Aye(s) with reservations: none . 0 No(es): none. 0 Excused: none. |
| Apr 22, 2025 | Received notice of reconsideration and Senate agreement (Sen. Com. No. 857). |
| Apr 22, 2025 | One Day Notice 04-23-25 |
| Apr 22, 2025 | Senate agrees with House amendments. Placed on the calendar for Final Reading on 04-23-25. |
| Apr 22, 2025 | Reconsideration of action taken on 04-08-25 in disagreeing to the House amendments. |
| Apr 8, 2025 | Received notice of disagreement (Sen. Com. No. 774). |
| Apr 8, 2025 | Senate disagrees with House amendments. |
| Apr 8, 2025 | Received from House (Hse. Com. No. 609). |
| Apr 4, 2025 | Passed Third Reading as amended in HD 2 with none voting aye with reservations; none voting no (0) and Representative(s) Cochran excused (1). Transmitted to Senate. |
| Apr 2, 2025 | Forty-eight (48) hours notice Friday, 04-04-25. |
| Apr 2, 2025 | Reported from CPC (Stand. Com. Rep. No. 1778) as amended in HD 2, recommending passage on Third Reading. |
| Mar 25, 2025 | The committee on CPC recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 9 Ayes: Representative(s) Matayoshi, Chun, Ilagan, Iwamoto, Kong, Lowen, Marten, Tam, Pierick; Ayes with reservations: none; 0 Noes: none; and 1 Excused: Representative(s) Ichiyama. |
| Mar 21, 2025 | Bill scheduled to be heard by CPC on Tuesday, 03-25-25 2:00PM in House conference room 329 VIA VIDEOCONFERENCE. |
| Mar 21, 2025 | Passed Second Reading as amended in HD 1 and referred to the committee(s) on CPC with none voting aye with reservations; none voting no (0) and Representative(s) Cochran, Garrett, Kapela, Kitagawa, Ward excused (5). |
| Mar 21, 2025 | Reported from HLT (Stand. Com. Rep. No. 1423) as amended in HD 1, recommending passage on Second Reading and referral to CPC. |
| Mar 19, 2025 | The committee on HLT recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 9 Ayes: Representative(s) Takayama, Keohokapu-Lee Loy, Amato, Chun, Marten, Olds, Takenouchi, Alcos, Garcia; Ayes with reservations: none; 0 Noes: none; and 0 Excused: none. |
| Mar 14, 2025 | Bill scheduled to be heard by HLT on Wednesday, 03-19-25 9:05AM in House conference room 329 VIA VIDEOCONFERENCE. |
| Mar 6, 2025 | Referred to HLT, CPC, referral sheet 19 |
| Mar 6, 2025 | Pass First Reading |
| Mar 4, 2025 | Received from Senate (Sen. Com. No. 324) in amended form (SD 2). |
| Mar 4, 2025 | Report adopted; Passed Third Reading, as amended (SD 2). Ayes, 25; Aye(s) with reservations: none . Noes, 0 (none). Excused, 0 (none). Transmitted to House. |
| Feb 27, 2025 | 48 Hrs. Notice 03-04-25. |
| Feb 27, 2025 | Reported from CPN (Stand. Com. Rep. No. 739) with recommendation of passage on Third Reading, as amended (SD 2). |
| Feb 19, 2025 | The committee(s) on CPN recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in CPN were as follows: 4 Aye(s): Senator(s) Keohokalole, Fukunaga, McKelvey, Awa; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Richards. |
| Feb 14, 2025 | The committee(s) on CPN will hold a public decision making on 02-19-25 9:35AM; Conference Room 229 & Videoconference. |
| Feb 14, 2025 | Report adopted; Passed Second Reading, as amended (SD 1) and referred to CPN. |
| Feb 14, 2025 | Reported from HHS (Stand. Com. Rep. No. 515) with recommendation of passage on Second Reading, as amended (SD 1) and referral to CPN. |
| Feb 5, 2025 | The committee(s) on HHS recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in HHS were as follows: 4 Aye(s): Senator(s) San Buenaventura, Aquino, Hashimoto, Keohokalole; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Fevella. |
| Jan 31, 2025 | The committee(s) on HHS has scheduled a public hearing on 02-05-25 1:00PM; Conference Room 225 & Videoconference. |
| Jan 27, 2025 | Referred to HHS, CPN. |
| Jan 23, 2025 | Introduced and passed First Reading. |
| Jan 21, 2025 | Pending Introduction. |
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Date
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Description
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Location
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Votes
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| Apr 23, 2025 | Final Reading | Senate Floor |
Passed |
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| Apr 4, 2025 | Third Reading | House Floor |
Passed |
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| Mar 25, 2025 | The committee on CPC recommend that the measure be PASSED, WITH AMENDMENTS | House Standing Committee on Consumer Protection & Commerce |
Passed |
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| Mar 19, 2025 | The committee on HLT recommend that the measure be PASSED, WITH AMENDMENTS | House Standing Committee on Health |
Passed |
|
| Mar 4, 2025 | Third Reading | Senate Floor |
Passed |
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| Feb 19, 2025 | The committee(s) on CPN recommend(s) that the measure be PASSED, WITH AMENDMENTS | Senate Standing Committee on Commerce and Consumer Protection |
Passed |
|
| Feb 5, 2025 | The committee(s) on HHS recommend(s) that the measure be PASSED, WITH AMENDMENTS | Senate Standing Committee on Health and Human Services |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
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Organization
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Position
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Date
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| Department of Human Services | ** Support |
STAND. COM. REP. NO. 1778
Honolulu, Hawaii
, 2025
RE: S.B. No. 1411
S.D. 2
H.D. 2
Honorable Nadine K. Nakamura
Speaker, House of Representatives
Thirty-Third State Legislature
Regular Session of 2025
State of Hawaii
Madame:
Your Committee on Consumer Protection & Commerce, to which was referred S.B. No. 1411, S.D. 2, H.D. 1, entitled:
"A BILL FOR AN ACT RELATING TO MEDICAID THIRD PARTY LIABILITY,"
begs leave to report as follows:
Your Committee finds that section 202 of Division P of the Consolidated Appropriations Act, 2022, P.L. 117-103 (section 202), amends section 1902(a)(25)(I) of the Social Security Act to require states to have laws that bar responsible third-party payers (other than Medicare plans) from refusing payment for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer's rules. Specifically, if the responsible third party requires prior authorization for an item or a service furnished to a Medicaid-eligible individual, the responsible third party must accept the authorization provided by the state that the item or service is covered under the state plan (or waiver of such plan) for the individual, as if such authorization was made by the third party for the item or service.
Your Committee further finds that measure amends state law to be in compliance with the requirements of section 202 and will allow the Department of Human Services to submit a federally required Medicaid State Plan Amendment attesting to such, which it cannot do without the amendments proposed in this measure.
Your Committee has amended this measure by:
(1) Changing the effective date to upon approval; and
(2) Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.
As affirmed by the record of votes of the members of your Committee on Consumer Protection & Commerce that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1411, S.D. 2, H.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1411, S.D. 2, H.D. 2.
Respectfully submitted on behalf of the members of the Committee on Consumer Protection & Commerce,
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____________________________ SCOT Z. MATAYOSHI, Chair |
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STAND. COM. REP. NO. 1423
Honolulu, Hawaii
, 2025
RE: S.B. No. 1411
S.D. 2
H.D. 1
Honorable Nadine K. Nakamura
Speaker, House of Representatives
Thirty-Third State Legislature
Regular Session of 2025
State of Hawaii
Madame:
Your Committee on Health, to which was referred S.B. No. 1411, S.D. 2, entitled:
"A BILL FOR AN ACT RELATING TO MEDICAID THIRD PARTY LIABILITY,"
begs leave to report as follows:
The purpose of this measure is to amend third party liability provisions for Medicaid programs for payment as required under the federal Consolidated Appropriations Act, 2022.
Your Committee received testimony in support of this measure from the Department of Human Services.
Your Committee finds that updates to state law are necessary to conform to new third party liability requirements included in the federal Consolidated Appropriations Act, 2022. This measure requires certain third-party payers to be responsible for reimbursing Medicaid providers based on the standards of the Medicaid program and prohibits providers from denying payment based on other standards.
Your Committee has amended this measure by:
(1) Changing the effective date to July 1, 3000, to encourage further discussion; and
(2) Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.
As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1411, S.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1411, S.D. 2, H.D. 1, and be referred to your Committee on Consumer Protection & Commerce.
Respectfully submitted on behalf of the members of the Committee on Health,
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____________________________ GREGG TAKAYAMA, Chair |
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STAND. COM. REP. NO. 739
Honolulu, Hawaii
RE: S.B. No. 1411
S.D. 2
Honorable Ronald D. Kouchi
President of the Senate
Thirty-Third State Legislature
Regular Session of 2025
State of Hawaii
Sir:
Your Committee on Commerce and Consumer Protection, to which was referred S.B. No. 1411, S.D. 1, entitled:
"A BILL FOR AN ACT RELATING TO MEDICAID THIRD PARTY LIABILITY,"
begs leave to report as follows:
The purpose and intent of this measure is to clarify third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act of 2022.
Your Committee received testimony in support of this measure from the Department of Human Services.
Your Committee finds that the federal Consolidated Appropriations Act of 2022 amended the Social Security Act to establish new state requirements relating to third-party liability for health care services rendered to Medicaid beneficiaries. The new requirements prohibit responsible third-party payers from refusing payment based on a lack of prior authorization under the third-party payer's rules and require third-party payers to be responsible for reimbursing Medicaid providers based on standards of the Medicaid program. This measure conforms state law to the new federal requirements to increase accountability and transparency in health care.
Your Committee has amended this measure by inserting an effective date of July 1, 2050, to encourage further discussion.
As affirmed by the record of votes of the members of your Committee on Commerce and Consumer Protection that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1411, S.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1411, S.D. 2.
Respectfully submitted on behalf of the members of the Committee on Commerce and Consumer Protection,
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________________________________ JARRETT KEOHOKALOLE, Chair |
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STAND. COM. REP. NO. 515
Honolulu, Hawaii
RE: S.B. No. 1411
S.D. 1
Honorable Ronald D. Kouchi
President of the Senate
Thirty-Third State Legislature
Regular Session of 2025
State of Hawaii
Sir:
Your Committee on Health and Human Services, to which was referred S.B. No. 1411 entitled:
"A BILL FOR AN ACT RELATING TO MEDICAID THIRD PARTY LIABILITY,"
begs leave to report as follows:
The purpose and intent of this measure is to clarify third-party liability provisions for medical assistance program claims for payment as required under the federal Consolidated Appropriations Act, 2022.
Your Committee received testimony in support of this measure from the Department of Human Services.
Your Committee finds that section 202 of the Consolidated Appropriations Act, 2022, amended section 1902(a)(25)(I) of the Social Security Act to require state Medicaid programs to have state laws in place that bar responsible third-party payers, other than Medicare plans, from refusing payment for an item or service solely on the basis that the item or service did not receive prior authorization under the third-party payer's rules. Your Committee further finds that the amendments also modified the requirement for a third-party payer to respond to a state inquiry regarding a health claim that is submitted no later than three years after the provision of the item or service to specify that the third party must respond within sixty days of receiving the inquiry. This measure amends existing state law to comply with the federal requirements amended pursuant to section 202 of the Consolidated Appropriations Act, 2022.
Your Committee has amended this measure by making technical, nonsubstantive amendments for the purposes of clarity and consistency.
As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1411, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1411, S.D. 1, and be referred to your Committee on Commerce and Consumer Protection.
Respectfully submitted on behalf of the members of the Committee on Health and Human Services,
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________________________________ JOY A. SAN BUENAVENTURA, Chair |
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Date
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Testimony PDF
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| Mar 25, 2025 | SB1411_HD1_TESTIMONY_CPC_03-25-25_.PDF |
| Mar 18, 2025 | SB1411_SD2_TESTIMONY_HLT_03-19-25_.PDF |
| Feb 18, 2025 | SB1411_SD1_TESTIMONY_CPN_02-19-25_.PDF |
| Feb 5, 2025 | SB1411_TESTIMONY_HHS_02-05-25_.PDF |
Discussed in Hearing
51SEC
Senate Floor
39SEC
House Standing Committee on Consumer Protection & Commerce
1MIN
House Standing Committee on Health
1MIN
House Standing Committee on Human Services & Homelessness
Bill Author
Bill Co-Author(s):