Bill > HB250

This bill addresses the challenges of prior authorization in healthcare by establishing two key mechanisms to improve the process. First, it requires utilization review entities (organizations that determine medical necessity before services are provided) to submit annual data about prior authorization to the State Health Planning and Development Agency, including details about approval, denial, and processing times. Second, the bill creates a Health Care Appropriateness and Necessity Working Group composed of representatives from insurance companies, healthcare professionals, and consumers, tasked with developing recommendations to streamline and improve the prior authorization process. The working group will research national scientific standards, clinical guidelines, and appropriate use criteria for common medical treatments, assess when prior authorization is necessary, recommend review standards, and monitor federal developments. The bill is motivated by significant concerns about prior authorization, including findings that 95% of physicians report it increases burnout, 83% of denials are ultimately overturned, and the process can potentially delay or harm patient care. While the working group's recommendations will be advisory, the state agency is required to promote them and report on their implementation, with the ultimate goal of reducing administrative burdens and ensuring timely, appropriate patient care.

Budget and Finance, Business and Industry, Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=HB&billnumber=250&year=2025