| 43 | | - | WHEREAS, although health insurance providers' prior authorization requirements are intended to ensure that medical services are necessary, cost-effective, and eligible for coverage, these requirements can cause critical medical treatments and tests to be delayed; and WHEREAS, the misapplication of prior authorization requirements can be especially harmful for rural and medically underserved patients, who already face significant barriers to accessing health care; and WHEREAS, prior authorization requirements can also create undue administrative burdens for health care providers, including providers in medically underserved areas; and WHEREAS, the federal Centers for Medicare and Medicaid Services (CMS) have mandated changes to prior authorization rules that will help reduce the burdens of prior authorization on certain patients and physicians; and WHEREAS, these changes do not benefit private payers in the State not covered by the CMS rules, who still require prior authorization for many common services; and WHEREAS, recommendations are needed to reduce the impact of prior authorization requirements on the delivery of health care to all patients in the State; now, therefore, BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Administrator of the State Health Planning and Development Agency is urged to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the State; and BE IT FURTHER RESOLVED that the Administrator of the State Health Planning and Development Agency be requested to invite the following to be members of the working group: (1) Five members representing the insurance industry, to be selected by the Hawaii Association of Health Plans; (2) Five members representing licensed health care professionals, two of whom to be selected by the Hawaii Medical Association, two of whom to be selected by the Healthcare Association of Hawaii, and one of whom to be selected by the Hawaii State Center for Nursing; and (3) Five members representing consumers of health care or employers, two of whom to be selected by the Board of Trustees of the Employer-Union Health Benefits Trust Fund, one of whom to be a consumer selected by the Statewide Health Coordinating Council, one of whom to be selected by the Hawaii Primary Care Association, and one of whom to be selected by Papa Ola Lokahi; and BE IT FURTHER RESOLVED that the Director of Health, Insurance Commissioner, and Administrator of the Med-QUEST Division of the Department of Human Services, or their designees, are requested to serve as ex-officio members of the working group; and BE IT FURTHER RESOLVED that the working group is requested to consider all relevant federal law, Hawaii law, and law in other states to determine whether there are statutes and regulations that establish: (1) Reasonable and appropriate prior authorization response times, including whether a response time of twenty-four hours for urgent care and forty-eight hours for non-urgent care is feasible; (2) Prior authorizations for medications valid for a period of at least one year, regardless of dosage changes; (3) Prior authorizations valid for the length of treatment for patients having chronic conditions; (4) That adverse determinations should only be made by providers licensed in the State and of the same specialty that typically manages the patient's conditions; (5) The manner in which retroactive denials may be avoided if care is preauthorized; (6) Procedures whereby private insurers may publicly release prior authorization data, disaggregated by drug or service, as it relates to approvals, denials, appeals, wait times, and other categories; (7) Reasonable and appropriate periods of time for a new health plan to honor a patient's prior authorization for a transitional period of time; and (8) Criteria or factors that would allow for a reduction in the total volume of prior authorization requests, such as exemptions or gold-carding programs; and BE IT FURTHER RESOLVED that the working group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Administrator of the State Health Planning and Development Agency, Director of Health, Insurance Commissioner, Administrator of the Med-QUEST Division of the Department of Human Services, Chairperson of the Board of Trustees of the Employer-Union Health Benefits Trust Fund, Chief Executive Officer of the Hawaii Medical Service Association, President of the Hawaii Medical Association, President of the Hawaii Association of Health Plans, Chief Executive Officer of the Healthcare Association of Hawaii, Director of the Center for Nursing, and Chief Executive Officer of Papa Ola Lokahi. Report Title: DHS; Health Insurance Reform; Prior Authorization; Working Group; Report |
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| 43 | + | WHEREAS, although health insurance providers' prior authorization requirements are intended to ensure that medical services are necessary, cost-effective, and eligible for coverage, these requirements can cause critical medical treatments and tests to be delayed; and WHEREAS, the misapplication of prior authorization requirements can be especially harmful for rural and medically underserved patients, who already face significant barriers to accessing health care; and WHEREAS, prior authorization requirements can also create undue administrative burdens for health care providers, including providers in medically underserved areas; and WHEREAS, the federal Centers for Medicare and Medicaid Services (CMS) have mandated changes to prior authorization rules that will help reduce the burdens of prior authorization on certain patients and physicians; and WHEREAS, these changes do not benefit private payers in the State not covered by the CMS rules, who still require prior authorization for many common services; and WHEREAS, recommendations are needed to reduce the impact of prior authorization requirements on the delivery of health care to all patients in the State; now, therefore, BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Director of Health is urged to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the State; and BE IT FURTHER RESOLVED that the working group is requested to comprise: (1) The Director of Health, or the Director's designee; (2) The Chair of the Senate Standing Committee on Health and Human Services, or a member appointed by the President of the Senate; (3) The Chair of the House of Representatives Standing Committee on Health, or a member appointed by the Speaker of the House of Representatives; (4) Administrator of the Med-QUEST Division of the Department of Human Services, or the Administrator's designee; (5) Five members representing the health insurance industry, to be selected by the Hawaii Association of Health Plans and invited by the Director of Health to participate; (6) Five members representing licensed health care professionals, two of whom shall be selected by the Hawaii Medical Association, two of whom shall be selected by the Healthcare Association of Hawaii, and one of whom shall be selected by the Center for Nursing, to be invited by the Director of Health to participate; and (7) Five members representing consumers of health care or employers, two of whom shall be selected by the board of trustees of the Employer-Union Health Benefits Trust Fund, one of whom shall be a consumer selected by the Statewide Health Coordinating Council, one of whom shall be selected by the Hawaii Primary Care Association, and one of whom shall be selected by Papa Ola Lokahi, to be invited by the Director of Health to participate; and BE IT FURTHER RESOLVED that the working group is requested to consider all relevant federal law, Hawaii law, and law in other states to determine whether there are statutes and regulations that establish: (1) Reasonable and appropriate prior authorization response times, including whether a response time of twenty-four hours for urgent care and forty-eight hours for non-urgent care is feasible; (2) Prior authorizations for medications valid for a period of at least one year, regardless of dosage changes; (3) Prior authorizations valid for the length of treatment for patients having chronic conditions; (4) That adverse determinations should only be made by providers licensed in the State and of the same specialty that typically manages the patient's conditions; (5) The manner in which retroactive denials may be avoided if care is preauthorized; (6) Procedures whereby private insurers may publicly release prior authorization data, disaggregated by drug or service, as it relates to approvals, denials, appeals, wait times, and other categories; (7) Reasonable and appropriate periods of time for a new health plan to honor a patient's prior authorization for a transitional period of time; and (8) Criteria or factors that would allow for a reduction in the total volume of prior authorization requests, such as exemptions or gold-carding programs; and BE IT FURTHER RESOLVED that the working group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, Chair of the Senate Standing Committee on Health and Human Services, Chair of the House of Representatives Standing Committee on Health, Administrator of the Med-QUEST Division of the Department of Human Services, Chairperson of the Board of Trustees of the Employer-Union Health Benefits Trust Fund, Chief Executive Officer of the Hawaii Medical Service Association, President of the Hawaii Medical Association, President of the Hawaii Association of Health Plans, Chief Executive Officer of the Healthcare Association of Hawaii, Director of the Center for Nursing, and Chief Executive Officer of Papa Ola Lokahi. Report Title: DHS; Health Insurance Reform; Prior Authorization; Working Group; Report |
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