RELATING TO MEDICAID THIRD PARTY LIABILITY.

Budget Healthcare

Active

The official status still shows this bill as active or still awaiting another formal step.

Sponsor: NAKAMURA (Introduced by request of another party)
Last action: 2025-12-08
Official status: Carried over to 2026 Regular Session.
Effective date: Not listed

Plain English Breakdown

The bill summary and text do not provide specific enforcement mechanisms or consequences for non-compliance.

Medicaid Third Party Liability Rules

This bill amends state laws to comply with federal requirements regarding third party liability in Medicaid claims.

What This Bill Does

Amends state laws to match new federal rules on third party liability for Medicaid program claims as required by the Consolidated Appropriations Act, 2022.
Requires health insurers to respond within sixty days if the state asks them about a claim submitted not later than three years after the provision of such item or service.
Does not allow health insurers to refuse payment solely because they did not get prior authorization from Medicaid.

Who It Names or Affects

Health insurance companies
The state government and its departments

Terms To Know

Third Party Liability: When someone else, like a health insurance company, is responsible for paying medical bills.
Prior Authorization: Permission from an insurance company to cover a specific medical service or treatment before it happens.

Limits and Unknowns

The bill does not specify how the changes will be enforced.
It is unclear what will happen if health insurers do not comply with these new rules.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

HD1

Hawaii published version HD1

Plain English: This amendment updates state law to comply with federal requirements regarding Medicaid third party liability, specifically addressing how health insurers must respond to inquiries from the State and handle claims.

Health insurers must now respond to any inquiry by the State within sixty calendar days about a health care claim submitted not later than three years after the provision of the item or service.
Health insurers cannot deny a claim submitted by the State solely because it lacks prior authorization, if the claim is made within three years and legal action starts within six years from submission.
When a responsible third party requires prior authorization for an item or service provided to someone eligible for Medicaid, they must accept the state's authorization as valid.

The effective date of July 1, 3000 is likely incorrect and may be intended to be a placeholder or error in the draft bill.

Bill History

2025-12-08 D
Carried over to 2026 Regular Session.
2025-02-12 H
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, Sayama, Ward excused (3).
2025-02-12 H
Reported from HLT (Stand. Com. Rep. No. 446) as amended in HD 1, recommending passage on Second Reading and referral to CPC.
2025-02-07 H
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.
2025-02-05 H
Bill scheduled to be heard by HLT on Friday, 02-07-25 8:45AM in House conference room 329 VIA VIDEOCONFERENCE.
2025-01-23 H
Referred to HLT, CPC, referral sheet 3
2025-01-23 H
Introduced and Pass First Reading.
2025-01-21 H
Pending introduction.

Official Summary Text

RELATING TO MEDICAID THIRD PARTY LIABILITY.
Medicaid; Third Party Liability; State Medical Assistance Program Claims
Amends third party liability provisions for Medicaid program claims for payment as required under the federal Consolidated Appropriations Act, 2022. Effective 7/1/3000. (HD1)

Current Bill Text

Read the full stored bill text

HB1092

HOUSE OF REPRESENTATIVES

H.B. NO.

1092

THIRTY-THIRD LEGISLATURE, 2025

STATE OF HAWAII

A BILL FOR AN ACT

RELATING
TO MEDICAID THIRD PARTY LIABILITY
.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

����
SECTION 1.
�
The legislature 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 such item or
service did not receive prior authorization under the third party payer's
rules.
�
It also modified the requirement
for a third party payer to respond to a state inquiry regarding a health claim
that is submitted not later than three years after the provision of such item
or service to specify that the third party must respond within sixty days of
receiving the inquiry.

����
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.

INTRODUCED BY:

_____________________________

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.