Bill > HB857

This bill requires all health insurance providers in Hawaii, including accident and health insurers, mutual benefit societies, and health maintenance organizations, to adopt prior authorization procedures that align with Medicare guidelines starting January 1, 2026. The bill mandates specific requirements for these prior authorization processes, such as establishing time frames for decision-making (24 hours for urgent requests and 3 calendar days for non-urgent requests), with automatic approval if no response is given within those timeframes. Insurers must base approval criteria on nationally recognized evidence-based guidelines and Medicare's medical necessity standards, and cannot require more documentation than Medicare. The bill also requires insurers to publish their prior authorization criteria online, provide advance notice of changes to policyholders, and prohibits retroactive denial of previously authorized services except in cases of fraud or misrepresentation. Additionally, the bill establishes a process for peer-to-peer reviews of claim denials and allows policyholders or healthcare providers to request an administrative hearing with the commissioner if they disagree with a denial. The legislation does not apply to employee benefit plans covered by the Employee Retirement Income Security Act and does not mandate coverage of services deemed not medically necessary.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=HB&billnumber=857&year=2026