Bill > SB1138

This bill requires health insurers in Hawaii to streamline and standardize their prior authorization processes by aligning them with Medicare policies, with the goal of reducing administrative burdens and improving patient care. Specifically, the bill mandates that insurers make urgent prior authorization requests within 24 hours and non-urgent requests within 3 calendar days, with any request automatically approved if not responded to within those timeframes. The bill also requires insurers to base their decisions on national evidence-based medical guidelines, limit documentation requirements, ensure prior authorizations remain valid for the duration of treatment (or at least 90 days), and prohibit retroactive payment denials except in cases of fraud or misrepresentation. The legislation empowers the insurance commissioner to conduct annual audits, investigate complaints, and publish quarterly reports on insurers' prior authorization performance. Insurers found in violation could face serious consequences, including potential license suspension, public disclosure of violations, and mandatory corrective action plans. The bill applies to various types of health insurers like health maintenance organizations and preferred provider organizations, but excludes federally regulated health plans and Medicare Advantage plans. The overall aim is to create a more efficient, transparent, and patient-centered prior authorization process in Hawaii.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=1138&year=2026