Bill > HB1130

This bill requires utilization review entities (organizations that evaluate the medical necessity of healthcare services) operating in Hawaii to submit detailed annual data about prior authorization (a process where health insurers must approve certain medical services before they are provided) to the State Health Planning and Development Agency. The reporting must include specific data points such as patient demographics, procedure codes, diagnosis codes, healthcare provider specialty, service settings, and the status of prior authorization requests. The bill was motivated by findings from medical surveys indicating that prior authorization significantly increases administrative burdens for healthcare providers, potentially delays patient care, and may lead to serious adverse medical events. The state agency must compile this data by insurance provider, healthcare setting, and business line, and publish a report with findings and recommendations by March 1st of the following year. The bill strictly limits the submission of protected health information, ensuring patient privacy, and defines precise parameters for what constitutes prior authorization data. Importantly, the legislation aims to provide transparency and insight into prior authorization practices in Hawaii, potentially helping to address inefficiencies and patient care challenges in the healthcare system.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=HB&billnumber=1130&year=2026