Bill > SB2282

This bill establishes a Prior Authorization Committee to identify specific medical conditions for which health insurance companies will not require prior authorization, meaning patients won't need pre-approval from their insurer before receiving treatment for those conditions. For all other conditions, health insurance companies, referred to as "insurers," must align their prior authorization processes with Medicare policies, which are the federal health insurance program for individuals aged 65 and older, and certain younger people with disabilities. This alignment includes strict timelines for approving or denying requests: urgent requests must be decided within 24 hours, and non-urgent requests within seven calendar days, with requests automatically approved if insurers fail to meet these deadlines. Insurers will also be required to use documentation that is no more burdensome than what Medicare requires and base their decisions on recognized medical guidelines. Prior authorizations will generally be valid for the duration of treatment or 90 days, whichever is longer, and insurers cannot retroactively deny payment for authorized services except in cases of fraud, intentional misrepresentation, or non-compliance with policy terms. The bill also mandates that insurers report data on their prior authorization processes to the state commissioner, who will conduct audits and investigate complaints, with insurers facing penalties for violations. This legislation aims to reduce administrative burdens on healthcare providers, improve patient access to timely medical services, and ensure greater consistency in how health insurance coverage is authorized.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=2282&year=2026