Bill > SB1138

This bill establishes comprehensive regulations for prior authorization processes in health insurance, requiring insurers in Hawaii to align their procedures with Medicare policies. The bill mandates that urgent prior authorization requests be decided within 24 hours and non-urgent requests within three calendar days, with any request automatically approved if not responded to within the specified timeframe. Insurers must base decisions on nationally recognized medical guidelines, limit documentation requirements to match or be less burdensome than Medicare's, and ensure prior authorizations remain valid for the duration of treatment or 90 days. The bill prohibits retroactive denial of pre-authorized services except in cases of fraud or intentional misrepresentation, and requires insurers to submit quarterly reports detailing their prior authorization request volumes and response times. The state insurance commissioner will conduct annual audits, investigate complaints, and has the authority to impose penalties for non-compliance, including potential license suspension. Providers and patients can appeal denials directly to the commissioner, who must issue a binding decision within 30 days. The law applies to various types of health insurers, including health maintenance organizations and preferred provider organizations, but excludes federally regulated health plans and Medicare Advantage plans.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=1138&year=2025