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SB 1519

RELATING TO PRIOR AUTHORIZATION.

2025 Regular Session Introduced by Brandon Elefante and 1 co-sponsor

SB 1519 improves prior authorization by requiring insurers to report denials, disclose criteria, and meet decision timelines, enhancing patient access to necessary care.

Carried over to 2026 Regular Session.
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Bill Summary · SB 1519

Summary of SB 1519: Relating to Prior Authorization

Bill Number: SB 1519
Introduced On: January 22, 2025
Current Status: Referred to CPN/HHS, WAM/JDC
Classification: Legislative Bill
Related Bills: HB 954 (companion bill)

Purpose and Intent

SB 1519 aims to enhance transparency and accountability in the prior authorization process for health care services. The bill seeks to address concerns regarding adverse determinations made by insurance companies and to streamline the utilization review process. By doing so, it intends to improve patient access to necessary medical services while ensuring that insurance practices are fair and transparent.

Key Provisions

The bill includes several important provisions:

  • Adverse Determination Reporting:
    Insurance companies will be required to provide clear and comprehensive reports on adverse determinations related to prior authorizations. This will include the reasons for denial and any relevant clinical guidelines used in the decision-making process.

  • Utilization Review Entity Oversight:
    The bill mandates that the Insurance Commissioner oversee utilization review entities to ensure compliance with established standards and practices. This oversight aims to protect patients from unjust denials of care.

  • Transparency Requirements:
    Insurers will be obligated to disclose their prior authorization criteria and processes to both healthcare providers and patients. This transparency is intended to facilitate better understanding and navigation of the prior authorization landscape.

  • Timelines for Decisions:
    The bill proposes specific timelines within which insurers must make prior authorization decisions, thereby reducing delays in patient care.

Impact

Who Will Be Affected?

  • Patients:
    Patients seeking medical services will benefit from clearer communication regarding prior authorization requirements and faster decision-making processes.

  • Healthcare Providers:
    Providers will have access to more transparent information about the criteria used by insurers, enabling them to better assist their patients in navigating the prior authorization process.

  • Insurance Companies:
    Insurers will need to adjust their practices to comply with the new reporting and transparency requirements, which may involve additional administrative responsibilities.

Procedural Aspects

  • Legislative Timeline:
    • The bill was introduced and passed its First Reading on January 23, 2025.
    • It was referred to the Committees on Commerce, Consumer Protection, and Health (CPN/HHS) and Ways and Means (WAM)/Judiciary and Hawaiian Affairs (JDC) on January 27, 2025.

Conclusion

SB 1519 represents a significant step towards reforming the prior authorization process in healthcare. By emphasizing transparency and accountability, the bill aims to improve patient access to necessary medical services while ensuring that insurance practices are fair and just. As the bill progresses through the legislative process, its implications for patients, providers, and insurers will continue to be closely monitored.

Compiled from official sources — confirm details with the bill’s official record.

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