April 15, 2016

Hawaii Senate Passes Bill Setting Preauthorization Standards

The Hawaii State Senate has passed legislation defining standards for the administration of preauthorization requirements enforced by the state’s health care insurers.

In response to health care provider complaints about long delays for preauthorization required before diagnostic procedures and medical treatments, House Bill 2740 would exempt emergency medicine from preauthorization. Preauthorization services would be required to be available 24-hours a day, seven days a week to assure timely order assessment and approval.

To address medicolegal concerns, H.R. 2740 would require licensed health care providers to be defended and indemnified by an insurer for civil liability for injury to a patient that was caused by undue preauthorization delays. Before passage, the Senate deleted language that would have required inquiries associated with preauthorization denial or undue delay disputes to be filed with the state Medical Inquiry and Conciliation Panel.

The legislation requires preauthorization to be based on current, evidence-based appropriateness use criteria or guidelines for the specialty or subspecialty for which it is requested. The standard would require insurers to consult with health care providers in the insurer’s network to ensure that evidence-based appropriate use criteria or guidelines are known and used.

The Hawaii Radiological Society has been joined by the American College of Radiology to support H.R. 2740.

The legislation was introduced in the Hawaii Legislature after the Hawaii Service Association (HMSA), an independent licensee of Blue Cross Blue Shield of Hawaii, implemented mandatory preauthorization in December 2015 for physicians who seek advanced medical imaging procedures, such as MRI or CT. The preauthorization requirement applies to Blue Cross Blue Shield coverage for more than half of the 1.4 million residents of the Hawaiian Islands. HMSA contracted National Imaging Associates, a radiology benefits management company in Arizona, to administer the program.

H.R. 2740 will now be referred to joint Assembly-Senate conference committee for review.