Relating To Insurer Prior Authorization.
If enacted, SB1138 will amend Chapter 431 of the Hawaii Revised Statutes by introducing new provisions governing the prior authorization processes of health insurers. This includes stipulations that urgent authorization requests be responded to within 24 hours and non-urgent requests within three calendar days. Should insurers fail to meet these timeframes, the request will be considered approved. Additionally, the bill mandates that documentation requirements must not be more burdensome than those set by Medicare for similar services, thereby addressing the complexities that often frustrate healthcare providers.
Senate Bill 1138 aims to address the challenges posed by prior authorization processes in Hawaii's healthcare system. The bill highlights concerns that these processes can delay treatment and negatively impact patient outcomes while imposing significant administrative burdens on healthcare providers. To counter these issues, the bill proposes streamlining prior authorization requirements to enhance patient care and improve access to medical services in alignment with established Medicare guidelines. By enforcing measures to expedite decision-making on authorization requests, the bill seeks to position Hawaii as a leader in healthcare reform.
Notably, the bill establishes strict consequences for insurers that violate its provisions, including potential suspension or revocation of their state licensure for egregious non-compliance. The proposed legislation also allows providers and patients to appeal denials directly to the commissioner, making the oversight process more accessible. Some stakeholders may express concerns over how this regulatory change affects insurers' operational autonomy and their ability to manage costs, given the requirements to adhere closely to Medicare standards.