Bill > SB1449

This bill addresses the challenges of prior authorization (a health plan process requiring advance approval for specific medical services) by establishing two key mechanisms: first, it requires utilization review entities (insurance companies or third-party administrators) to submit detailed annual data about their prior authorization processes to the State Health Planning and Development Agency, including information like patient demographics, procedure codes, and request statuses. Second, the bill creates a Health Care Appropriateness and Necessity Working Group composed of 15 members representing insurers, healthcare professionals, and consumers, which will research and make recommendations to improve the prior authorization process. The working group will determine national scientific standards for common medical treatments, assess the appropriateness of prior authorization requirements, recommend review standards and timeframes, and submit reports to the legislature. The bill is motivated by findings that prior authorization significantly burdens healthcare providers, potentially delays or compromises patient care, and results in a high percentage of initial denials being overturned upon appeal. While the working group's recommendations will be advisory, the state agency is tasked with promoting them and tracking their adoption, with the ultimate goal of reducing administrative obstacles and improving healthcare service efficiency.

Business and Industry, Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=1449&year=2026