HRS § 103F-107 - Medicaid contracts; nonprofits and for-profits; reporting requirements
AI-assisted research summary: Medicaid healthcare insurance contractors must file an annual report each year, and the department of human services must pass the reporting rules into contracts and later send a written analysis to the legislature.
(a) All nonprofit or for-profit medicaid healthcare insurance contractors, within one hundred and eighty days following the close of each fiscal year, shall submit an annual report to the department of human services, the insurance division of the department of commerce and consumer affairs, and the legislature. The report shall be attested to by a plan executive located within the State and shall be made accessible to the public. The report shall be based on contracts administered in the State and shall include: (1) An accounting of expenditures of MedQuest contract payments for the contracted services, including the percentage of payments: (A) For medical services; (B) For administrative costs; (C) Held in reserve; and (D) Paid to shareholders; (2) Employment information including: (A) Total number of full-time employees hired for the contracted services; (B) Total number of employees located in the State and the category of work performed; and (C) The compensation provided to each of the five highest paid Hawaii employees and to each of the five highest paid employees nationwide, and a description of each position; (3) Descriptions of any ongoing state or federal sanction proceedings, prohibitions, restrictions, ongoing civil or criminal investigations, and descriptions of past sanctions or resolved civil or criminal cases, within the past five years and related to the provision of medicare or medicaid services by the contracting entity, to the extent allowed by law; (4) Descriptions of contributions to the community, including the percentage of revenue devoted to Hawaii community development projects and health enhancements; provided that contracted services shall not be included in the percentage calculation; and (5) A list of any management and administrative service contracts for MedQuest services made in Hawaii and outside of the State, including a description of the purpose and cost of those contracts. (b) The department of human services shall include in all medicaid healthcare insurance plan contracts, the annual reporting requirements of subsection (a). (c) Any contract under this section shall be governed by the laws of the State of Hawaii. (d) Within ninety days of receipt of the reports required by this section, the department of human services shall provide a written analysis and comparative report to the legislature. [L Sp 2009, c 12, §2]