HI HB248

Requires health carriers and utilization review organizations to certify non-emergency services within two business days for non-urgent services or one business day for urgent services, with services deemed certified if the deadline is missed.

Prohibits prospective review requirements for pre-hospital transportation and emergency services, and requires carriers to allow 24 hours (or until the next business day if on holiday/weekend) to notify of emergency admissions.

Requires adverse determination notices to include the reviewing provider's credentials, clinical review criteria used, information on how to request reports, appeal procedures, and complaint contact information for state regulators.

Prohibits carriers from revoking certifications within 45 working days of authorization and voids any contractual provisions that attempt to waive prospective review protections.

Mandates health carriers disclose all prospective review requirements and statistics on certifications/denials by physician specialty, medication/procedure, and denial reason on their websites, with 60 days' notice before implementing new requirements.