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.

SCR175

THE SENATE

S.C.R. NO.

175

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

SENATE CONCURRENT

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, the House of Representatives concurring, 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 Concurrent 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.

OFFERED BY:

_____________________________

Report Title:
�

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