RELATING TO PRIOR AUTHORIZATION OF HEALTH CARE SERVICES.

2025 Regular Session Introduced by Ron Kouchi

SB 1449 mandates annual data reporting on prior authorizations to improve transparency, reduce provider burdens, and enhance patient care in Hawaii's health system.

Carried over to 2026 Regular Session.

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Purpose and Intent

Senate Bill 1449 (SB 1449) aims to address the administrative burdens associated with the prior authorization process in health care. Prior authorization requires health care providers to obtain approval from health plans before delivering certain services to patients. The bill seeks to enhance transparency and accountability in this process by mandating data reporting to the State Health Planning and Development Agency (SHPDA).

Key Provisions

Data Reporting Requirement:

Utilization review entities operating in Hawaii must submit annual data related to prior authorization of health care services to SHPDA.
The data must include patient demographics, procedure codes, diagnosis codes, and the status of prior authorization requests (e.g., pending, approved, denied).
Reports are due by January 31 of the following year, with SHPDA required to publish findings by March 1.

Protection of Health Information:

The bill stipulates that protected health information should not be submitted unless authorized by the individual or as permitted under federal regulations.

Definition of Terms:

The bill defines "prior authorization" and "utilization review entity," clarifying the scope of the legislation.

Impact

Health Care Providers:

The bill is expected to alleviate some of the administrative burdens faced by health care providers, who have reported that prior authorization processes contribute to physician burnout and delays in patient care.
A 2023 survey indicated that 95% of physicians believe prior authorization increases administrative workload, with significant percentages reporting adverse patient outcomes due to delays.

Patients:

By improving the transparency of prior authorization processes, the bill aims to enhance patient care and safety, potentially reducing delays in receiving necessary medical services.

Health Plans:

Health plans will need to adapt to the new reporting requirements, which may lead to changes in how they manage prior authorization processes.

Procedural Aspects

Legislative Timeline:

SB 1449 was introduced on January 21, 2025, and has undergone several readings and amendments in both the Senate and House.
The bill is currently in the conference committee stage, with meetings scheduled to finalize its provisions.

Related Legislation:

A companion bill, House Bill 1130 (HB 1130), has been introduced, indicating a broader legislative interest in reforming prior authorization practices.

Conclusion

SB 1449 represents a significant step towards reforming the prior authorization process in Hawaii, aiming to reduce administrative burdens on health care providers and improve patient care outcomes. By requiring data reporting, the bill seeks to create a more accountable and transparent system that benefits both providers and patients.

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