HI HB857

Requires all accident and health insurers, mutual benefit societies, and health maintenance organizations in Hawaii to adopt prior authorization policies equivalent to Medicare guidelines for policies issued or renewed after December 31, 2025

Mandates response time frames of 24 hours for urgent prior authorization requests and 3 calendar days for non-urgent requests, with automatic approval if deadlines are missed

Prohibits retroactive denial of payment for services that received prior authorization, except in cases of fraud, intentional misrepresentation, or explicit policy non-compliance

Requires prior authorization approvals to last 90 days or the entire course of treatment (whichever is longer), and limits documentation requirements to no more than what Medicare requires

Establishes a peer-to-peer review process within 24 hours of claim denial and creates an administrative hearing process through the insurance commissioner for disputed denials, with commissioner orders issued within 30 days of hearing conclusion