Bill > SB832

This bill requires health insurers in Hawaii to streamline and standardize their prior authorization processes, aligning them with Medicare policies to reduce administrative burdens and improve patient care. Specifically, the bill mandates that insurers decide urgent prior authorization requests within 24 hours and non-urgent requests within 3 calendar days, with requests automatically approved if not responded to within those timeframes. The legislation requires insurers to base decisions on nationally recognized medical guidelines, limit documentation requirements, and ensure prior authorizations remain valid for the treatment course or 90 days. The bill also prohibits retroactive denial of previously authorized services except in cases of fraud or misrepresentation, and establishes oversight mechanisms including mandatory quarterly reporting to the insurance commissioner and annual audits. Insurers found in violation could face penalties such as license suspension, public disclosure of violations, and mandatory corrective action plans. The bill applies to various types of health insurers, including health maintenance organizations and preferred provider organizations, but excludes federally regulated health plans. The overall goal is to improve healthcare efficiency, reduce treatment delays, and enhance patient access to medical services.