Relating To Prior Authorization Of Health Care Services.
SB1449 addresses prior authorization practices used by health insurers and other utilization review entities in Hawaii. The bill finds that prior authorization can create significant administrative burden for physicians, delay patient care, and in some cases contribute to adverse patient outcomes. In response, it requires entities that perform prior authorization to submit annual data to the state health planning and development agency, which must then compile and publish a report of findings and recommendations.
The bill also creates a Health Care Appropriateness and Necessity Working Group within the state agency. That group is tasked with identifying the most respected clinical standards, guidelines, and appropriate use criteria for common services that trigger prior authorization; evaluating whether prior authorization is appropriate for those services; recommending standards for reviewers, decision timeframes, and longer-duration approvals for chronic conditions; and reporting recommendations to the Legislature beginning before the 2026 session. The bill defines prior authorization, prior authorization data, and utilization review entity broadly enough to cover insurers, HMOs, mutual benefit societies, and other entities administering health benefits in the state.
If enacted, SB1449 would add new reporting and transparency requirements to Chapter 323D, Hawaii Revised Statutes, governing utilization review entities that conduct prior authorization. It would require annual submission of prior authorization data, while limiting disclosure of protected health information unless authorized or otherwise permitted under federal privacy rules. The state agency would be required to publish aggregated findings by insurer, setting, and line of business, and to report delays in publication to the Legislature. The bill would also establish an advisory working group to study and recommend improvements to prior authorization practices, but its recommendations would not be mandatory for insurers, providers, or other affected parties.
The available committee votes suggest generally favorable sentiment toward the bill. It passed the Senate Health and Human Services Committee 4-0 with amendments and later passed the Senate Commerce and Consumer Protection Committee 3-0 unamended. The bill text itself reflects a strong policy concern that prior authorization is burdensome and can delay medically necessary care, and it frames the measure as a transparency and process-improvement effort rather than a direct prohibition on prior authorization.
The main points of contention are likely to be the scope of data reporting, the administrative burden on utilization review entities, and how much discretion the state agency and working group should have in shaping future prior authorization standards. Insurers and utilization review entities may be concerned about compliance costs, data privacy, and operational impacts, while physicians, patients, and consumer advocates are likely to support the bill’s focus on reducing delays, burnout, and unnecessary denials. The bill attempts to balance these interests by making the working group’s recommendations advisory only and by including representatives from insurers, providers, consumers, and employers.