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 create administrative burdens. The bill requires utilization review entities (health insurers and similar organizations) to make their prior authorization requirements transparent by publishing detailed clinical criteria and approval/denial statistics on their websites. Key provisions include mandating that prior authorization decisions be made by physicians in the same specialty as the healthcare service being reviewed, setting strict time frames for approval or automatic approval of both non-urgent and urgent healthcare services, and prohibiting prior authorization for emergency services and medications for opioid use disorder. The bill also requires insurers to use electronic prior authorization standards by January 1, 2026, and mandates that utilization review entities submit annual reports to the Insurance Commissioner detailing their prior authorization request outcomes. Additionally, the legislation creates exemptions for healthcare providers with high prior authorization approval rates and ensures continuity of care by requiring prior authorizations to be honored for at least 90 days when a patient changes health plans. The overall goal is to improve patient care, reduce administrative obstacles, and increase transparency in the healthcare authorization process.

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https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=1519&year=2026