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HB 1299

TO PROHIBIT HEALTHCARE INSURERS FROM EXERCISING RECOUPMENT FOR PAYMENT OF HEALTHCARE SERVICES MORE THAN ONE YEAR AFTER THE PAYMENT FOR HEALTHCARE SERVICES WAS MADE.

2025 Regular Session Introduced by Missy Irvin and 1 co-sponsor

HB 1299 aimed to protect healthcare providers by limiting insurers' recoupment of payments to one year, ensuring financial stability and clearer communication on claims.

WITHDRAWN BY AUTHOR
0
WeVote Research Nonpartisan
Bill Summary · HB 1299

Summary of House Bill 1299

Bill Information

  • Bill Number: HB 1299
  • Title: To Prohibit Healthcare Insurers from Exercising Recoupment for Payment of Healthcare Services More Than One Year After the Payment for Healthcare Services Was Made
  • Status: Withdrawn by Author
  • Introduced: January 29, 2025
  • Classification: Bill

Purpose and Intent

House Bill 1299 aimed to establish a limitation on the ability of healthcare insurers to recoup payments made to healthcare providers. Specifically, the bill sought to prohibit insurers from reclaiming payments for healthcare services more than one year after those payments were made, except in cases of fraud, waste, or abuse.

Key Provisions

The bill proposed the following significant changes to existing law:

  1. Recoupment Limitation:

    • Healthcare insurers would only be allowed to exercise recoupment within 365 days of payment for healthcare services, barring instances of fraud, waste, or abuse.

  2. Notification Requirements:

    • Insurers must provide a written or electronic statement to healthcare providers detailing the basis for any recoupment actions, including:
      • The amount being recouped.
      • The name of the covered person.
      • The date of service and the specific healthcare service involved.

  3. Verification of Patient Eligibility:

    • Insurers would be prohibited from recouping payments if the healthcare provider verified patient eligibility for services in good faith.

  4. Appeal Process:

    • If a healthcare provider disputes a recoupment, the insurer must suspend recoupment efforts until the provider has exhausted all internal appeals.

  5. Definitions:

    • The bill included definitions for terms such as "abuse," "fraud," "waste," "health benefit plan," "healthcare insurer," and "healthcare provider," clarifying the scope and application of the legislation.

Impact

If enacted, HB 1299 would have primarily affected:
- Healthcare Providers: By providing them with greater protection against retroactive payment recoveries, enhancing financial stability and predictability in their operations.
- Healthcare Insurers: By imposing stricter regulations on their recoupment practices, potentially affecting their financial management and claims processing.

Legislative Actions

  • March 17, 2025: The bill was withdrawn by the author.
  • February 20, 2025: The bill was placed on second reading for amendment and Amendment No. 1 was adopted.
  • January 29, 2025: The bill was filed and referred to the Committee on Insurance & Commerce.

Conclusion

While HB 1299 was withdrawn before it could be enacted, its provisions highlighted ongoing concerns regarding the practices of healthcare insurers and the financial implications for healthcare providers. The proposed legislation aimed to create a more equitable framework for payment recoupment in the healthcare sector.

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

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