Bill > HB857

This bill requires all health insurance providers in Hawaii, including accident and health insurers, mutual benefit societies, and health maintenance organizations, to align their prior authorization processes with Medicare guidelines starting January 1, 2026. Specifically, the bill mandates that insurers establish policies for prior authorization that include specific time frames for processing requests (24 hours for urgent requests, 3 days for non-urgent requests), with automatic approval if no response is given within those timeframes. The bill also requires insurers to base approval criteria on nationally recognized evidence-based guidelines, limit documentation requirements to Medicare levels, and provide prior authorization for at least 90 days or the entire course of treatment. Additionally, the bill establishes a process for appealing prior authorization denials, requiring insurers to offer peer-to-peer reviews and allowing policyholders or healthcare providers to request an administrative hearing with the insurance commissioner if they disagree with a denial. Insurers must publish their prior authorization criteria on their websites and provide advance notice of any changes. The bill aims to streamline and standardize the prior authorization process, making it more transparent and efficient for patients and healthcare providers, while explicitly noting that it does not mandate coverage of medically unnecessary services and does not apply to certain employee benefit plans.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=HB&billnumber=857&year=2025