SR 170: requesting health maintenance organizations in the state to adhere to and be held accountable for issuing timely reimbursements of health care claims pursuant to THE STATE'S CLEAN CLAIMS STATUTE.

SENATE RESOLUTION

requesting health maintenance organizations in the state to adhere to and be held accountable for issuing timely reimbursements of health care claims pursuant to THE STATE'S CLEAN CLAIMS STATUTE.

     WHEREAS, article IX, section 10, of the Constitution of the State of Hawaii directs the State to provide for the safety of the people from crimes against persons and property; and

     WHEREAS, timely payment of health insurance claims is critical to maintaining patients' access to medical care and ensuring the financial stability of health care providers; and

     WHEREAS, delays in reimbursement harm health care businesses and medical practices and negatively impact patients and consumers, and numerous medical businesses face financial distress or closure where delayed reimbursement is a significant contributing factor; and

     WHEREAS, section 431:13-108, Hawaii Revised Statutes, also known as the Clean Claims Statute, requires health maintenance organizations operating under chapter 432D, Hawaii Revised Statutes, to issue reimbursement for uncontested claims within thirty days after receipt, or within fifteen days for electronically submitted claims; and

     WHEREAS, enforcement of section 431:13-108, Hawaii Revised Statutes, by the Insurance Division of the Department of Commerce and Consumer Affairs appears to occur infrequently and is often driven by after-the-fact complaints rather than consistent oversight; and

     WHEREAS, when reimbursements are not issued in a timely manner, health care providers may be forced to allocate payroll and operating expenses while awaiting reimbursement; and

     WHEREAS, delayed payments may contribute to the failure of medical practices, thereby placing the health and safety of the population at risk; and

     WHEREAS, these impacts disproportionately affect rural and underserved communities; now, therefore,

     BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2026, that health maintenance organizations in the State are requested to adhere to and be held accountable for issuing timely reimbursements of health care claims pursuant to the State's Clean Claims Statute; and

     BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Governor, Director of Health, Director of Human Services, Director of Commerce and Consumer Affairs, Administrator of the State Health Planning and Development Agency, and Insurance Commissioner.

Report Title: 

Health Maintenance Organizations; Reimbursement; Health Care Claims; Clean Claims