HB 1130 Summary

• Requires utilization review entities doing business in Hawaii to submit annual data on prior authorization of health care services to the State Health Planning and Development Agency by January 31 each year.

• State agency must post the reporting format on its website at least three months before the reporting period begins and must compile and post findings by March 1 of the following year.

• Prior authorization data must include patient demographics, procedure and diagnosis codes, provider specialty, care setting, request and response dates, and authorization status (pending, approved, denied, appealed, overturned).

• Protected health information may only be submitted with individual authorization or when permitted under federal regulations (45 CFR 164.512).

• Defines "utilization review entity" to include health insurers, accident and health plans, mutual benefit societies, fraternal benefit societies, health maintenance organizations, and any other entity providing or administering health benefits.