HI SB1274

Adds a new Part to Hawaii's Patients' Bill of Rights and Responsibilities Act establishing uniform standards for external review of health insurance adverse determinations, complying with the federal Patient Protection and Affordable Care Act of 2010.

Creates procedures for both standard external review (within 45 days) and expedited external review (within 72 hours) of health carrier denials involving medical necessity, appropriateness, health care setting, level of care, or effectiveness.

Requires health carriers to pay for independent review organization costs and establishes minimum qualifications for independent review organizations, including conflict-of-interest protections and clinical reviewer standards.

Sets a $15 filing fee for external review requests (capped at $60 per enrollee per plan year) that is refundable if the adverse determination is reversed, with waiver available for financial hardship.

Repeals the existing external review procedure in section 432E-6 and updates definitions in chapter 432E to align with federal requirements, with implementation effective June 30, 2011 or later depending on federal guidance.