Part I.  General Provisions


     432E-1 Definitions

   432E-1.4 Medical necessity

   432E-1.5 Licensure of managed care plan medical directors

     432E-2 Conflict with other laws


           Part II.  General Policies

     432E-3 Repealed

     432E-4 Enrollee participation in treatment decisions

     432E-5 Complaints and appeals procedure for enrollees

     432E-6 Repealed

   432E-6.5 Expedited internal appeal, when authorized;

            standard for decision

     432E-7 Information to enrollees

     432E-8 Enforcement


           Part III.  Reporting and Other Provisions

     432E-9 Utilization review

    432E-10 Managed care plan performance measurement and

            data reporting standards

    432E-11 Accreditation of managed care plans

    432E-12 Rules

    432E-13 Annual report


           Part IV.  External Review of Health Insurance


    432E-31 Applicability and scope

    432E-32 Notice of right to external review

    432E-33 Request for external review

    432E-34 Standard external review

    432E-35 Expedited external review

    432E-36 External review of experimental or

            investigational treatment adverse


    432E-37 Binding nature of external review decision

    432E-38 Approval of independent review organizations

    432E-39 Minimum qualifications for independent review


    432E-40 Hold harmless for independent review


    432E-41 External review reporting requirements

    432E-42 Funding of external review

    432E-43 Disclosure requirements

    432E-44 Rules




  The amendments made to this chapter by L 2011, c 230 have a transitional effective date and are subject to the insurance commissioner's emergency rulemaking authority for conformance to the federal Patient Protection and Affordable Care Act and a conditional repeal and reenactment provision.  L 2011, c 230, §§14, 17.


Cross References


  Health care provider network adequacy, see chapter 432F.


Law Journals and Reviews


  Hawai‘i's Patients' Bill of Rights:  Saving the Right to External Review.  28 UH L. Rev. 295 (2005).


Case Notes


  As chapter 432D does not cover the field of managed care regulation and because §§432D-2, 432E-1, and article 431:10A can be read together and there is no explicit language or policy reason not to give each statute effect, chapter 432D does not repeal this chapter by implication.  126 H. 326, 271 P.3d 621 (2012).


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