H.B. 954 - Ensuring Transparency in Prior Authorization Act

• Establishes comprehensive regulatory framework for prior authorization processes in Hawaii, requiring utilization review entities to make requirements and clinical criteria readily accessible on websites in understandable language.

• Mandates 48-hour automatic approval for non-urgent prior authorization requests and 24-hour automatic approval for urgent requests if insurers fail to approve, deny, or request additional information within specified timeframes.

• Prohibits prior authorization requirements for emergency health care services, pre-hospital transportation, and medications for opioid use disorder; requires coverage of emergency services necessary to screen and stabilize patients.

• Requires adverse determinations and appeals to be reviewed by physicians with appropriate licensing, specialty experience, and qualifications; physicians reviewing appeals must be independent with no financial interest in outcome.

• Mandates health insurers use NCPDP SCRIPT Standard electronic prior authorization by January 1, 2026; requires annual reporting to Insurance Commissioner with approval/denial statistics by service; authorizes automatic approval if insurers fail to comply with chapter provisions.