Relating To Prior Authorization.
SB1519 establishes a comprehensive new Hawaii law governing prior authorization, to be titled the Ensuring Transparency in Prior Authorization Act. It requires utilization review entities, including insurers, HMOs, PPOs, and other entities administering health benefits, to publicly disclose prior authorization requirements, clinical criteria, and approval/denial statistics, and to give advance notice before adding or changing requirements. The bill also sets qualifications for physicians who make adverse determinations and appeal decisions, including specialty matching, active practice experience, and independence from the reviewing entity on appeal.
The bill imposes strict timelines for prior authorization decisions: non-urgent requests are deemed approved after 48 hours if no action is taken, and urgent requests after 24 hours, with shorter follow-up windows for additional information. It prohibits prior authorization for emergency health care services, pre-hospital transportation, and medications for opioid use disorder, and it requires coverage and prompt determination for emergency stabilization and post-stabilization care. It also limits retrospective denials, requires prior authorizations to remain valid for at least one year or for the duration of chronic treatment, and creates continuity-of-care protections when patients change plans or insurers.
SB1519 would significantly affect Hawaii insurance and health care administration by shifting more decision-making power toward treating providers and patients and away from utilization review entities. It would amend the Hawaii Revised Statutes by adding a new chapter and would require the Insurance Commissioner to adopt implementing rules by January 1, 2026. The bill also requires annual reporting by utilization review entities and a yearly summary report to the Legislature, with recommendations to remove prior authorization requirements for services that are approved at least 80 percent of the time.
The overall sentiment reflected in the bill text is strongly favorable to reforming prior authorization, with the legislature describing the current system as opaque, burdensome, and harmful to patient care. The bill frames prior authorization as something that should not interfere with the physician-patient relationship or delay medically necessary treatment. No committee transcripts or votes were provided, so there is no recorded external debate or formal vote history to indicate broader support or opposition.
The main points of contention likely concern the bill’s operational burden on insurers and utilization review entities, the short automatic-approval deadlines, and the broad prohibition on prior authorization for certain services. Health plans may view the reporting, disclosure, and physician-review requirements as costly and restrictive, while providers and patient advocates are likely to support the transparency, faster turnaround, and exemption provisions. The automatic-approval penalty for noncompliance is especially significant and could be a major issue in implementation discussions.
The bill would add a new chapter to the Hawaii Revised Statutes creating a detailed regulatory framework for prior authorization. It would impose disclosure, notice, reporting, physician-qualification, timing, and appeal requirements on utilization review entities and insurers, while also prohibiting prior authorization for emergency services, pre-hospital transportation, and medications for opioid use disorder. It would further require electronic prior authorization standards for pharmacy benefits by January 1, 2026, and direct the Insurance Commissioner to adopt rules and oversee annual reporting.
The bill’s tone is strongly reform-oriented and patient-protective. Its findings and operative provisions reflect concern that prior authorization has become too complex, delayed, and opaque, and the measure is designed to reduce barriers to care, increase transparency, and limit insurer control over medical decision-making. Because no committee discussion or vote record was provided, there is no documented legislative debate in the materials, but the text itself suggests clear support for significant prior authorization reform.
Likely areas of contention include the bill’s strict automatic-approval deadlines, the prohibition on prior authorization for certain categories of care, and the requirement that adverse determinations and appeals be handled by physicians with specific specialty and practice qualifications. Insurers and utilization review entities may object to the administrative and financial burden of public reporting, advance notice, continuity-of-care obligations, and the 80 percent exemption standard for providers. Providers and patient advocates are likely to support these provisions, especially the emergency-care protections, opioid use disorder treatment exemption, and limits on retrospective denials.