Committee backs HB 250, endorses state work group to standardize prior authorization criteria

The committee approved House Bill 250 (HD1) after proponents argued the state should adopt a data-driven, multi‑stakeholder approach to reform prior authorization and automate decisions using agreed‑upon appropriateness criteria.

SHIP (State Health Planning and Development Agency) testified the science and standards exist and that an appropriateness and necessity body could harmonize clinical criteria across payers, providers and consumers to automate approvals at the point of care. “If we, as a state, could agree on the standards…we could then automate this process and it would be done,” a SHIP representative told the committee.

Supporters including the Hawaii Medical Association, primary-care and safety-net providers, and patient advocates testified that prior authorization delays care, contributes to provider burnout and can lead to worse outcomes. Provider witnesses said many prior authorizations are ultimately approved and that the process creates avoidable costs and delays.

Opponents and insurers urged caution and recommended reporting to the insurance commissioner because of pending federal timelines and CMS rules. HMSA and the Hawaii Association of Health Plans said new federal requirements for PA timelines, transparency and electronic processing are coming and asked that statutory reporting be coordinated with the appropriate regulator.

Committee action: The committee adopted SHIP’s proposed composition for the body (15-member work group representing insurers, providers and consumers), accepted HMA’s amendment to allow two weeks for providers to respond to information requests, and passed HB 250 with amendments. The committee also noted collaboration with the insurance commissioner for reporting and implementation.