HOUSE OF REPRESENTATIVES

H.B. NO.

885

TWENTY-NINTH LEGISLATURE, 2017

H.D. 1

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO DELAY IN PRIOR APPROVAL FOR MEDICAL SERVICES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. Prior approval for medical services, also known as precertification or preauthorization, refers to health insurer requirements that certain physician-ordered treatments or services must be approved in advance by the insurer or by a medical review service contracted by the insurer before the insurer will provide final reimbursement or payment. Health insurers claim that preauthorization requirements encourage the safety of plan participants, promote appropriate utilization of services, and ensure ongoing efficiency in the setting of health care costs. However, as currently applied by some health insurers in the State, preauthorization requirements also create gaps in necessary and often critical health care coverage, especially in the areas of advanced imaging studies such as magnetic resonance imagery and computed tomography testing.

The legislature finds that it is in the best interest of the State to ensure that preauthorization requirements do not negatively impact the health of Hawaii residents.

The purpose of this Act is to:

(1) Prohibit insurers from requiring preauthorization that causes undue delay in a patient's receipt of medical treatment or services; and

(2) Clarify insurer and licensed health care provider liability for patient injuries caused by preauthorization delays.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"431:10A-   Preauthorization; undue delay; liability. (a) Notwithstanding any provision of the law to the contrary, no insurer shall require preauthorization of medical services or treatments so as to cause an undue delay in a patient's receipt of medical treatment or services.

(b) For the purposes of this section, "undue delay" means an unreasonable delay in medical treatment or services that may cause the exacerbation or worsening of a health condition due to:

(1) Insufficient time to obtain a first-time preauthorization from an insurer or unwarranted rejection by an insurer of a first-time preauthorization;

(2) Administrative difficulties or delays in receiving preauthorization from insurers; and

(3) Difficulties arising from noncommunication by insurers on the tests and procedures that require preauthorization;

provided that response times for preauthorization requests that exceed the response times permitted for preauthorization requests by medicaid, medicare, or other federal plans or programs for the same medical treatment or service shall be deemed an "undue delay".

(c) Notwithstanding any provision of the law to the contrary, a licensed health care provider shall be defended and indemnified by an insurer for civil liability for injury to a patient that was caused by the insurer's undue delay in preauthorizing medical treatment or services.

(d) An insurer that violates subsection (a) shall be civilly liable for any injury that occurs to a patient because of undue delay in the receipt of medical treatment or services.

(e) A licensed health care provider shall provide treatment or services without waiting for preauthorization whenever an undue delay in a patient's receipt of medical treatment or services may cause the exacerbation or worsening of a health condition. An insurer that disputes that it was reasonable to proceed without preauthorization has the burden of proving that a licensed health care provider did not have a reasonable belief that it was necessary to provide treatment or services without waiting for preauthorization."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432-   Preauthorization; undue delay; liability. (a) Notwithstanding any provision of the law to the contrary, no insurer shall require preauthorization of medical services or treatments so as to cause an undue delay in a patient's receipt of medical treatment or services.

(b) For the purposes of this section, "undue delay" means an unreasonable delay in medical treatment or services that may cause the exacerbation or worsening of a health condition due to:

(1) Insufficient time to obtain a first-time preauthorization from an insurer or unwarranted rejection by an insurer of a first-time preauthorization;

(2) Administrative difficulties or delays in receiving preauthorization from insurers; and

(3) Difficulties arising from noncommunication by insurers on the tests and procedures that require preauthorization;

provided that response times for preauthorization requests that exceed the response times permitted for preauthorization requests by medicaid, medicare, or other federal plans or programs for the same medical treatment or service shall be deemed an "undue delay".

(c) Notwithstanding any provision of the law to the contrary, a licensed health care provider shall be defended and indemnified by an insurer for civil liability for injury to a patient that was caused by the insurer's undue delay in preauthorizing medical treatment or services.

(d) An insurer that violates subsection (a) shall be civilly liable for any injury that occurs to a patient because of undue delay in the receipt of medical treatment or services.

(e) A licensed health care provider shall provide treatment or services without waiting for preauthorization whenever an undue delay in a patient's receipt of medical treatment or services may cause the exacerbation or worsening of a health condition. An insurer that disputes that it was reasonable to proceed without preauthorization has the burden of proving that a licensed health care provider did not have a reasonable belief that it was necessary to provide treatment or services without waiting for preauthorization."

SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, [and 431:10A-134,] 431:10A-  , and chapter 431M."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 7. This Act shall take effect on July 1, 3000.



 

Report Title:

Liability; Preauthorization; Health Insurance

 

Description:

Prohibits health insurance preauthorization requirements that cause undue delay in receipt of medical treatment or services. Specifies that insurers, but not health care providers, are liable for civil damages caused by undue delays for preauthorization. (HB885 HD1)

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.