HI HB1130

Requires utilization review entities doing business in Hawaii to submit annual prior authorization data to the State Health Planning and Development Agency by January 31 for the preceding calendar year

Mandates the state agency compile data by health insurance provider, healthcare setting, and line of business, and publish findings with recommendations by March 1 of the following year

Required data includes patient demographics (sex, age, ZIP code), procedure and diagnosis codes, drug names, provider specialty, healthcare setting, and timeline of authorization requests including approval, denial, appeal, and overturn dates

Cites American Medical Association survey findings that 95% of physicians attribute prior authorization to increased burnout, 94% report it delays care, and 19% report it has caused serious adverse events requiring hospitalization

References Kaiser Family Foundation analysis showing 83% of prior authorization appeals in Medicare Advantage resulted in overturning the initial denial in 2022