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GM 1159

Informing the Legislature that on May 15, 2025, the Governor signed the following bill into law: SB1411 SD2 HD2 (ACT 059).

2025 Regular Session

Act 059 improves Hawaii's Medicaid by ensuring timely payments from insurers, enhancing access for recipients, and allowing state recovery from third-party payers.

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Bill Summary · GM 1159

Summary of GM 1159: Informing the Legislature of Act 059

Bill Number: GM 1159
Title: Informing the Legislature that on May 15, 2025, the Governor signed the following bill into law: SB1411 SD2 HD2 (ACT 059)
Status: Received
Introduced: May 15, 2025
Classification: Proclamation
Subject: Act 059

Purpose and Intent

GM 1159 serves as a formal notification to the Hawaii State Legislature that the Governor has signed into law Senate Bill 1411 (SB1411), which is now designated as Act 059. The primary intent of Act 059 is to amend state laws regarding Medicaid third-party liability to ensure compliance with federal requirements established by the Consolidated Appropriations Act of 2022.

Key Provisions

Act 059 introduces several important changes to Hawaii's Medicaid program:

  1. Third-Party Payer Compliance:

    • The Act mandates that responsible third-party payers (excluding Medicare) cannot deny payment for healthcare items or services solely based on the absence of prior authorization.

  2. Timely Response Requirements:

    • Third-party payers must respond to state inquiries regarding health claims within 60 days of receiving the inquiry. This applies to claims submitted within three years of the service date.

  3. Insurer Reporting Obligations:

    • Health insurers are required to provide the State with information about their members, including coverage periods and details about the nature of the coverage.
    • Insurers must submit quarterly reports to an independent third-party entity that matches this data with the Department of Human Services to identify third-party liabilities.

  4. State's Right of Recovery:

    • The Act affirms the State's right to recover payments made for medical assistance from responsible third parties.

  5. Prior Authorization Acceptance:

    • If a third-party payer requires prior authorization for a service, they must accept authorization from the state Medicaid program as valid.

Who Would Be Affected?

  • Medicaid Recipients: Individuals receiving medical assistance under Hawaii's Medicaid program will benefit from improved access to services without the risk of denial based on prior authorization issues.
  • Health Insurers: Insurance companies operating in Hawaii will need to adjust their processes to comply with the new reporting and payment requirements.
  • State Agencies: The Department of Human Services will have enhanced capabilities to recover costs from third-party payers, potentially improving the financial sustainability of the Medicaid program.

Procedural Aspects

  • Approval Date: The bill was signed into law by Governor Josh Green on May 15, 2025.
  • Legislative Process: The bill passed through both the Senate and House of Representatives prior to receiving the Governor's approval, indicating a collaborative legislative effort.

Conclusion

GM 1159 serves as an important legislative proclamation that highlights the enactment of Act 059, which aligns Hawaii's Medicaid third-party liability laws with federal standards. This legislation aims to streamline processes, enhance accountability among insurers, and ultimately improve access to healthcare for Medicaid recipients in Hawaii.

Compiled from official sources — confirm details with the bill’s official record.

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