2010 Hawaii Code
DIVISION 2. BUSINESS
TITLE 24. INSURANCE
431L. Medicaid-Related Mandates
§431L-2.5 I nsurer requirements.

[§431L-2.5] I nsurer requirements. Any health insurer as identified in section 431L-1 shall:

(1) Provide, with respect to individuals who are eligible for, or are provided, medical assistance under Title 42 United States Code section 1396a (section 1902 of the Social Security Act), as amended, upon the request of the State, information 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) 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);

(3) Respond to any inquiry by the State regarding a 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

(4) 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, 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. [L 2009, c 103, §2]