Bill > SB1519

This bill establishes a comprehensive regulatory framework for prior authorization in healthcare, addressing the complex and often opaque process that can delay patient care and increase administrative burdens. The legislation requires utilization review entities (insurance companies and other health benefit administrators) to make their prior authorization requirements transparent by publishing detailed, easy-to-understand criteria on their websites. 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 received, 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 requires insurers to use standardized electronic prior authorization transactions by January 1, 2026, and mandates that these entities submit annual reports to the Insurance Commissioner detailing their prior authorization approval and denial rates. Notably, the bill introduces exemptions for healthcare providers with high approval rates and ensures that prior authorizations remain valid for at least one year. The legislation aims to prioritize patient care, reduce administrative obstacles, and increase transparency in the healthcare authorization process, with the ultimate goal of preventing cost-shifting and protecting the patient-physician relationship.

Business and Industry

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=1519&year=2025