Bill > HB954

This bill establishes a comprehensive regulatory framework for the prior authorization process in Hawaii, aimed at improving transparency, efficiency, and patient care in health insurance. The legislation requires utilization review entities (health insurers) to make their prior authorization requirements and restrictions publicly accessible, with clear and understandable language. Key provisions include mandating that prior authorization decisions for non-urgent services must be made within 48 hours, with automatic approval if no response is given, and for urgent services within 24 hours. The bill prohibits prior authorization for emergency health care services and medications for opioid use disorder. It also establishes qualifications for physicians making authorization decisions, requiring them to be of the same specialty as the provider requesting the service. The bill introduces new reporting requirements, with utilization review entities required to submit annual reports to the Insurance Commissioner detailing approval rates, denial rates, and processing times. Additionally, insurers must adopt electronic prior authorization standards using the NCPDP SCRIPT Standard by January 1, 2026. The legislation aims to reduce administrative burdens, improve patient care, and ensure that prior authorization is used judiciously, with a focus on medical necessity rather than cost-cutting.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=HB&billnumber=954&year=2026