Hawaii 2023 Regular Session

Hawaii House Bill HR158 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	HOUSE OF REPRESENTATIVES H.R. NO. 158 THIRTY-SECOND LEGISLATURE, 2023 STATE OF HAWAII HOUSE RESOLUTION requesting the department of labor and industrial relations to continue to recognize and accept the right of a provider of service to assign the right to participate in a workers' compensation billing dispute to a billing company.
2	2
3	3	HOUSE OF REPRESENTATIVES H.R. NO. 158
4	4	THIRTY-SECOND LEGISLATURE, 2023
5	5	STATE OF HAWAII
6	6
7	7	HOUSE OF REPRESENTATIVES
8	8
9	9	H.R. NO.
10	10
11	11	158
12	12
13	13	THIRTY-SECOND LEGISLATURE, 2023
14	14
15	15
16	16
17	17	STATE OF HAWAII
18	18
19	19
20	20
21	21
22	22
23	23
24	24
25	25
26	26
27	27
28	28
29	29	HOUSE RESOLUTION
30	30
31	31
32	32
33	33
34	34
35	35	requesting the department of labor and industrial relations to continue to recognize and accept the right of a provider of service to assign the right to participate in a workers' compensation billing dispute to a billing company.
36	36
37	37
38	38
39	39
40	40
41	41
42	42
43	43	WHEREAS, the Hawaii Territorial Legislature enacted the State's first workers' compensation law in 1915 to ensure that employees who were injured or disabled on the job were provided with medical treatment and fixed monetary awards; and WHEREAS, this law was Hawaii's first "no-fault" legislation in that it mandated there be a presumption that an employee's injuries were "work-related", while prohibiting an employee from filing civil actions against the employer for work-related injuries or illnesses; and WHEREAS, under existing law, any employer, including the state and county governments, employing one or more workers is required to provide workers' compensation coverage; and WHEREAS, the workers' compensation law defines "compensation" to mean "all benefits accorded by this chapter to an employee or the employee's dependents on account of a work injury as defined in this section; it includes medical and rehabilitation benefits, income and indemnity benefits in cases of disability or death, and the allowance for funeral and burial expenses"; and WHEREAS, as a business decision, employers frequently assign their rights to participate in a workers' compensation billing dispute regarding prescription medication claims (dispute) to an insurance carrier or other billing review company; and WHEREAS, section 12-15-1, Hawaii Administrative Rules (HAR), provides that a "provider of service" means any person or entity who is licensed, certified, recognized, or registered with the Department of Commerce and Consumer Affairs and who renders medical care, medical services, or medical supplies in accordance with chapter 386, Hawaii Revised Statutes (HRS); and WHEREAS, section 12-15-94(c), HAR, provides that the provider of service may file a "bill dispute request" to include a copy of the original bill with the Director of Labor and Industrial Relations within sixty calendar days after postmark of the employer's objection, and failure to do so shall be construed as acceptance of the employer's denial; and WHEREAS, section 386-57, HRS, relating to the legal status of right to compensation and compensation payments, provides that the right to compensation under chapter 386, HRS, shall: (1) Not be assignable, and the right to compensation and compensation payments received shall be exempt from the reach of creditors; and (2) Have the same status as a lien or the same priority for the whole thereof with respect to the assets of the employer as are accorded by law to any unpaid wages for labor; and WHEREAS, the Director of Labor and Industrial Relations has held since 2012, when the Director issued multiple decisions on this issue, and has repeatedly ruled consistently with those decisions, that section 386-57, HRS, is not applicable to a valid assignment of a dispute from a provider of service to a billing company because the section must be read in conjunction with the applicable definition of "compensation"; accordingly, section 386-57, HRS, only applies to the employee's or the employee's dependents' right to compensation, and a billing company assignee has "standing" to file a bill dispute request; and WHEREAS, since the 2012 decisions on standing were issued, the Director of Labor and Industrial Relations has recognized that billing companies are allowed to step into the shoes of a provider of service with the authority to participate in the dispute pursuant to section 12-15-94(d), HAR; and WHEREAS, the Director of Labor and Industrial Relations has consistently intervened in reimbursement disputes at the request of billing companies and issued multiple decisions without wavering on the issue of standing; and WHEREAS, the Legislature, in section 386-21.7, HRS, has also recognized the right of a provider of service's assignee to contract directly with an employer or carrier, or any entity acting on behalf of the employer or carrier, with regard to the payment for prescription drugs dispensed to an employee for a work injury; and WHEREAS, Act 231, Session Laws of Hawaii 2014, which was codified into law as section 386-21.7, HRS, stated, "This Act does not restrict and is not intended to restrict the ability of any physician, hospital, pharmacy, or provider of service other than a physician to dispense, bill for, and receive payment for prescription drugs that are reasonably needed as the nature of the injury requires."; and WHEREAS, permitting a provider of service's assignee to contract directly with an employer or carrier, or any entity acting on behalf of the employer or carrier, with regard to the payment for prescription drugs dispensed to an employee for a work injury, and denying the assignee standing to participate in the dispute process would produce an absurd and unjust result, and restrict the ability of a provider of service to receive payment for prescription drugs dispensed to an injured employee; and WHEREAS, opponents of this well-established precedent have recently attempted to undermine the ability of a provider of service to assign their rights to participate in a dispute to a billing company; and WHEREAS, citing an ambiguous decision by the Director of Labor and Industrial Relations that is currently under appeal, these opponents are using the same arguments that the Director considered and dismissed in the Director's 2012 decisions on standing, including claiming that section 386-57, HRS, prohibits the assignment of the right to participate in a dispute; and WHEREAS, these opponents are urging employers and carriers to refuse to recognize the right of billing companies to participate in disputes; and WHEREAS, if these opponents are successful, the outcome will restrict the ability of a provider of service to dispense, bill for, and receive payment for prescription drugs that are reasonably needed as the nature of the injury requires, contrary to the express language of Act 231, Session Laws of Hawaii 2014, and the intent of section 386-21.7, HRS; and WHEREAS, such a restriction will adversely impact the main goal of the workers' compensation system, which is to heal injured workers and return them to work as soon as reasonably possible; and WHEREAS, if these opponents are successful, employers and carriers may refuse to pay billings to a legitimate assignee billing company, causing a backlog in billing disputes with the Department of Labor and Industrial Relations; now, therefore, BE IT RESOLVED by the House of Representatives of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2023, that the Department of Labor and Industrial Relations is requested to continue to recognize and accept the right of a provider of service to assign the right to participate in a workers' compensation billing dispute to a billing company; and BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Labor and Industrial Relations and Director of Human Resources Development. OFFERED BY: _____________________________ Report Title: Workers' Compensation; Billing Disputes; Provider of Service; DLIR
44	44
45	45	WHEREAS, the Hawaii Territorial Legislature enacted the State's first workers' compensation law in 1915 to ensure that employees who were injured or disabled on the job were provided with medical treatment and fixed monetary awards; and
46	46
47	47
48	48
49	49	WHEREAS, this law was Hawaii's first "no-fault" legislation in that it mandated there be a presumption that an employee's injuries were "work-related", while prohibiting an employee from filing civil actions against the employer for work-related injuries or illnesses; and
50	50
51	51
52	52
53	53	WHEREAS, under existing law, any employer, including the state and county governments, employing one or more workers is required to provide workers' compensation coverage; and
54	54
55	55
56	56
57	57	WHEREAS, the workers' compensation law defines "compensation" to mean "all benefits accorded by this chapter to an employee or the employee's dependents on account of a work injury as defined in this section; it includes medical and rehabilitation benefits, income and indemnity benefits in cases of disability or death, and the allowance for funeral and burial expenses"; and
58	58
59	59
60	60
61	61	WHEREAS, as a business decision, employers frequently assign their rights to participate in a workers' compensation billing dispute regarding prescription medication claims (dispute) to an insurance carrier or other billing review company; and
62	62
63	63
64	64
65	65	WHEREAS, section 12-15-1, Hawaii Administrative Rules (HAR), provides that a "provider of service" means any person or entity who is licensed, certified, recognized, or registered with the Department of Commerce and Consumer Affairs and who renders medical care, medical services, or medical supplies in accordance with chapter 386, Hawaii Revised Statutes (HRS); and
66	66
67	67
68	68
69	69	WHEREAS, section 12-15-94(c), HAR, provides that the provider of service may file a "bill dispute request" to include a copy of the original bill with the Director of Labor and Industrial Relations within sixty calendar days after postmark of the employer's objection, and failure to do so shall be construed as acceptance of the employer's denial; and
70	70
71	71
72	72
73	73	WHEREAS, section 386-57, HRS, relating to the legal status of right to compensation and compensation payments, provides that the right to compensation under chapter 386, HRS, shall:
74	74
75	75
76	76
77	77	(1) Not be assignable, and the right to compensation and compensation payments received shall be exempt from the reach of creditors; and
78	78
79	79
80	80
81	81	(2) Have the same status as a lien or the same priority for the whole thereof with respect to the assets of the employer as are accorded by law to any unpaid wages for labor; and
82	82
83	83
84	84
85	85	WHEREAS, the Director of Labor and Industrial Relations has held since 2012, when the Director issued multiple decisions on this issue, and has repeatedly ruled consistently with those decisions, that section 386-57, HRS, is not applicable to a valid assignment of a dispute from a provider of service to a billing company because the section must be read in conjunction with the applicable definition of "compensation"; accordingly, section 386-57, HRS, only applies to the employee's or the employee's dependents' right to compensation, and a billing company assignee has "standing" to file a bill dispute request; and
86	86
87	87
88	88
89	89	WHEREAS, since the 2012 decisions on standing were issued, the Director of Labor and Industrial Relations has recognized that billing companies are allowed to step into the shoes of a provider of service with the authority to participate in the dispute pursuant to section 12-15-94(d), HAR; and
90	90
91	91
92	92
93	93	WHEREAS, the Director of Labor and Industrial Relations has consistently intervened in reimbursement disputes at the request of billing companies and issued multiple decisions without wavering on the issue of standing; and
94	94
95	95
96	96
97	97	WHEREAS, the Legislature, in section 386-21.7, HRS, has also recognized the right of a provider of service's assignee to contract directly with an employer or carrier, or any entity acting on behalf of the employer or carrier, with regard to the payment for prescription drugs dispensed to an employee for a work injury; and
98	98
99	99
100	100
101	101	WHEREAS, Act 231, Session Laws of Hawaii 2014, which was codified into law as section 386-21.7, HRS, stated, "This Act does not restrict and is not intended to restrict the ability of any physician, hospital, pharmacy, or provider of service other than a physician to dispense, bill for, and receive payment for prescription drugs that are reasonably needed as the nature of the injury requires."; and
102	102
103	103
104	104
105	105	WHEREAS, permitting a provider of service's assignee to contract directly with an employer or carrier, or any entity acting on behalf of the employer or carrier, with regard to the payment for prescription drugs dispensed to an employee for a work injury, and denying the assignee standing to participate in the dispute process would produce an absurd and unjust result, and restrict the ability of a provider of service to receive payment for prescription drugs dispensed to an injured employee; and
106	106
107	107
108	108
109	109	WHEREAS, opponents of this well-established precedent have recently attempted to undermine the ability of a provider of service to assign their rights to participate in a dispute to a billing company; and
110	110
111	111
112	112
113	113	WHEREAS, citing an ambiguous decision by the Director of Labor and Industrial Relations that is currently under appeal, these opponents are using the same arguments that the Director considered and dismissed in the Director's 2012 decisions on standing, including claiming that section 386-57, HRS, prohibits the assignment of the right to participate in a dispute; and
114	114
115	115
116	116
117	117	WHEREAS, these opponents are urging employers and carriers to refuse to recognize the right of billing companies to participate in disputes; and
118	118
119	119
120	120
121	121	WHEREAS, if these opponents are successful, the outcome will restrict the ability of a provider of service to dispense, bill for, and receive payment for prescription drugs that are reasonably needed as the nature of the injury requires, contrary to the express language of Act 231, Session Laws of Hawaii 2014, and the intent of section 386-21.7, HRS; and
122	122
123	123
124	124
125	125	WHEREAS, such a restriction will adversely impact the main goal of the workers' compensation system, which is to heal injured workers and return them to work as soon as reasonably possible; and
126	126
127	127
128	128
129	129	WHEREAS, if these opponents are successful, employers and carriers may refuse to pay billings to a legitimate assignee billing company, causing a backlog in billing disputes with the Department of Labor and Industrial Relations; now, therefore,
130	130
131	131
132	132
133	133	BE IT RESOLVED by the House of Representatives of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2023, that the Department of Labor and Industrial Relations is requested to continue to recognize and accept the right of a provider of service to assign the right to participate in a workers' compensation billing dispute to a billing company; and
134	134
135	135
136	136
137	137	BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Labor and Industrial Relations and Director of Human Resources Development.
138	138
139	139
140	140
141	141
142	142
143	143
144	144
145	145	OFFERED BY: _____________________________
146	146
147	147
148	148
149	149	OFFERED BY:
150	150
151	151	_____________________________
152	152
153	153	Report Title:
154	154
155	155	Workers' Compensation; Billing Disputes; Provider of Service; DLIR