Hawaii 2023 Regular Session

Hawaii Senate Bill SB324 Compare Versions

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

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1	1	THE SENATE S.B. NO. 324 THIRTY-SECOND LEGISLATURE, 2023 STATE OF HAWAII A BILL FOR AN ACT relating TO HEALTH CARE COST-SHARING ARRANGEMENTS. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	THE SENATE S.B. NO. 324
4	4	THIRTY-SECOND LEGISLATURE, 2023
5	5	STATE OF HAWAII
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7	7	THE SENATE
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9	9	S.B. NO.
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11	11	324
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13	13	THIRTY-SECOND LEGISLATURE, 2023
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	relating TO HEALTH CARE COST-SHARING ARRANGEMENTS.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 3 to be appropriately designated and to read as follows: "§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. INTRODUCED BY: _____________________________
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49	49	SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 3 to be appropriately designated and to read as follows:
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51	51	"§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:
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53	53	(1) The following information:
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55	55	(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;
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57	57	(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;
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59	59	(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;
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61	61	(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;
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63	63	(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;
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65	65	(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;
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67	67	(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;
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69	69	(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;
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71	71	(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;
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73	73	(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;
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75	75	(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;
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77	77	(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;
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79	79	(M) The specific counties in the State in which the person:
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81	81	(i) Offered a health care cost-sharing arrangement in the immediately preceding calendar year; and
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83	83	(ii) Intends to offer a health care cost-sharing arrangement in the next calendar year;
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85	85	(N) Other states in which the person offers a health care cost-sharing arrangement;
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87	87	(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:
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89	89	(i) Marketing, promoting, or enrolling participants in a health care cost-sharing arrangement offered by the person in the State; or
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91	91	(ii) Operating, managing, or administering a health care cost-sharing arrangement offered by the person in the State;
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93	93	(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;
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95	95	(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;
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97	97	(R) The name, mailing address, e-mail address, and telephone number of an individual serving as a contact for the person in the State;
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99	99	(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
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101	101	(T) An organizational chart for the person and a list of the officers and directors of the person;
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103	103	(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.
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105	105	(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.
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107	107	(c) If the commissioner determines that a person has failed to comply with the requirements of subsection (a), the commissioner shall:
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109	109	(1) Notify the person that the submission is incomplete and enumerate in the notification each deficiency found in the person's submission; and
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111	111	(2) Allow the person thirty days after notice of the incomplete submission to remedy the deficiency found in the submission.
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113	113	(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.
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115	115	(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.
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117	117	(f) The commissioner shall:
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119	119	(1) On or before April 1, 2024, and on or before each October 1 thereafter:
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121	121	(A) Prepare a written report summarizing the information submitted by persons pursuant to subsection (a); and
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123	123	(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
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125	125	(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.
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127	127	(g) The commissioner may adopt rules as necessary to implement this section.
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129	129	(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.
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131	131	(i) As used in this section:
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133	133	"Health care cost-sharing arrangement" means:
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135	135	(1) A health care sharing ministry, as defined in Title 26 United States Code section 5000A(d)(2)(B); or
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137	137	(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.
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139	139	"Producer" means a person required to be licensed under the laws of the State to sell, solicit, or negotiate insurance."
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141	141	SECTION 2. New statutory material is underscored.
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143	143	SECTION 3. This Act shall take effect upon its approval.
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147	147	INTRODUCED BY: _____________________________
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149	149	INTRODUCED BY:
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151	151	_____________________________
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157	157	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.
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161	161	Report Title:
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163	163	Insurance; Health Care Cost-Sharing Arrangements; Insurance Commissioner; Disclosures
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167	167	Description:
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169	169	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.
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177	177	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.