SCR 10: URGING THE ADMINISTRATOR OF THE STATE HEALTH PLANNING AND DEVELOPMENT AGENCY TO ESTABLISH A WORKING GROUP ON HEALTH INSURANCE REFORM TO PROVIDE RECOMMENDATIONS FOR REDUCING THE IMPACT OF PRIOR AUTHORIZATION REQUIREMENTS ON THE TIMELY DELIVERY OF HEALTH CARE IN THE STATE.

SENATE CONCURRENT

RESOLUTION

URGING THE ADMINISTRATOR OF THE STATE HEALTH PLANNING AND DEVELOPMENT AGENCY TO ESTABLISH A WORKING GROUP ON HEALTH INSURANCE REFORM TO PROVIDE RECOMMENDATIONS FOR REDUCING THE IMPACT OF PRIOR AUTHORIZATION REQUIREMENTS ON THE TIMELY DELIVERY OF HEALTH CARE IN THE STATE.

     WHEREAS, although health insurance providers' prior authorization requirements are intended to ensure that medical services are necessary, cost-effective, and eligible for coverage, these requirements can cause critical medical treatments and tests to be delayed; and

     WHEREAS, the misapplication of prior authorization requirements can be especially harmful for rural and medically underserved patients, who already face significant barriers to accessing health care; and

     WHEREAS, prior authorization requirements can also create undue administrative burdens for health care providers, including providers in medically underserved areas; and

     WHEREAS, the federal Centers for Medicare and Medicaid Services (CMS) have mandated changes to prior authorization rules that will help reduce the burdens of prior authorization on certain patients and physicians; and

     WHEREAS, these changes do not benefit private payers in the State not covered by the CMS rules, who still require prior authorization for many common services; and

     WHEREAS, recommendations are needed to reduce the impact of prior authorization requirements on the delivery of health care to all patients in the State; now, therefore,

     BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Administrator of the State Health Planning and Development Agency is urged to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the State; and

     BE IT FURTHER RESOLVED that the Administrator of the State Health Planning and Development Agency be requested to invite the following to be members of the working group:

     (1)  Five members representing the insurance industry, to be selected by the Hawaii Association of Health Plans;

     (2)  Five members representing licensed health care professionals, two of whom to be selected by the Hawaii Medical Association, two of whom to be selected by the Healthcare Association of Hawaii, and one of whom to be selected by the Hawaii State Center for Nursing; and

     (3)  Five members representing consumers of health care or employers, two of whom to be selected by the Board of Trustees of the Employer-Union Health Benefits Trust Fund, one of whom to be a consumer selected by the Statewide Health Coordinating Council, one of whom to be selected by the Hawaii Primary Care Association, and one of whom to be selected by Papa Ola Lokahi; and

     BE IT FURTHER RESOLVED that the Director of Health, Insurance Commissioner, and Administrator of the Med-QUEST Division of the Department of Human Services, or their designees, are requested to serve as ex-officio members of the working group; and

     BE IT FURTHER RESOLVED that the working group is requested to consider all relevant federal law, Hawaii law, and law in other states to determine whether there are statutes and regulations that establish:

     (1)  Reasonable and appropriate prior authorization response times, including whether a response time of twenty-four hours for urgent care and forty-eight hours for non-urgent care is feasible;

     (2)  Prior authorizations for medications valid for a period of at least one year, regardless of dosage changes;

     (3)  Prior authorizations valid for the length of treatment for patients having chronic conditions;

     (4)  That adverse determinations should only be made by providers licensed in the State and of the same specialty that typically manages the patient's conditions;

     (5)  The manner in which retroactive denials may be avoided if care is preauthorized;

     (6)  Procedures whereby private insurers may publicly release prior authorization data, disaggregated by drug or service, as it relates to approvals, denials, appeals, wait times, and other categories;

     (7)  Reasonable and appropriate periods of time for a new health plan to honor a patient's prior authorization for a transitional period of time; and

     (8)  Criteria or factors that would allow for a reduction in the total volume of prior authorization requests, such as exemptions or gold-carding programs; and

     BE IT FURTHER RESOLVED that the working group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and

     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Administrator of the State Health Planning and Development Agency, Director of Health, Insurance Commissioner, Administrator of the Med-QUEST Division of the Department of Human Services, Chairperson of the Board of Trustees of the Employer-Union Health Benefits Trust Fund, Chief Executive Officer of the Hawaii Medical Service Association, President of the Hawaii Medical Association, President of the Hawaii Association of Health Plans, Chief Executive Officer of the Healthcare Association of Hawaii, Director of the Center for Nursing, and Chief Executive Officer of Papa Ola Lokahi.

Report Title:

DHS; Health Insurance Reform; Prior Authorization; Working Group; Report

SENATE CONCURRENT

RESOLUTION

urging the director of health to establish a working group on HEALTH INSURANCE reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the state.

     WHEREAS, although health insurance providers' prior authorization requirements are intended to ensure that medical services are necessary, cost-effective, and eligible for coverage, these requirements can cause critical medical treatments and tests to be delayed; and

     WHEREAS, the misapplication of prior authorization requirements can be especially harmful for rural and medically underserved patients, who already face significant barriers to accessing health care; and

     WHEREAS, prior authorization requirements can also create undue administrative burdens for health care providers, including providers in medically underserved areas; and

     WHEREAS, the federal Centers for Medicare and Medicaid Services (CMS) have mandated changes to prior authorization rules that will help reduce the burdens of prior authorization on certain patients and physicians; and

     WHEREAS, these changes do not benefit private payers in the State not covered by the CMS rules, who still require prior authorization for many common services; and

     WHEREAS, recommendations are needed to reduce the impact of prior authorization requirements on the delivery of health care to all patients in the State; now, therefore,

     BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Director of Health is urged to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the State; and

     BE IT FURTHER RESOLVED that the working group is requested to comprise:

     (1)  The Director of Health, or the Director's designee;

     (2)  The Chair of the Senate Standing Committee on Health and Human Services, or a member appointed by the President of the Senate;

     (3)  The Chair of the House of Representatives Standing Committee on Health, or a member appointed by the Speaker of the House of Representatives;

     (4)  Administrator of the Med-QUEST Division of the Department of Human Services, or the Administrator's designee;

     (5)  Five members representing the health insurance industry, to be selected by the Hawaii Association of Health Plans and invited by the Director of Health to participate;

     (6)  Five members representing licensed health care professionals, two of whom shall be selected by the Hawaii Medical Association, two of whom shall be selected by the Healthcare Association of Hawaii, and one of whom shall be selected by the Center for Nursing, to be invited by the Director of Health to participate; and

     (7)  Five members representing consumers of health care or employers, two of whom shall be selected by the board of trustees of the Employer-Union Health Benefits Trust Fund, one of whom shall be a consumer selected by the Statewide Health Coordinating Council, one of whom shall be selected by the Hawaii Primary Care Association, and one of whom shall be selected by Papa Ola Lokahi, to be invited by the Director of Health to participate; and

     BE IT FURTHER RESOLVED that the working group is requested to consider all relevant federal law, Hawaii law, and law in other states to determine whether there are statutes and regulations that establish:

     (1)  Reasonable and appropriate prior authorization response times, including whether a response time of twenty-four hours for urgent care and forty-eight hours for non-urgent care is feasible;

     (2)  Prior authorizations for medications valid for a period of at least one year, regardless of dosage changes;

     (3)  Prior authorizations valid for the length of treatment for patients having chronic conditions;

     (4)  That adverse determinations should only be made by providers licensed in the State and of the same specialty that typically manages the patient's conditions;

     (5)  The manner in which retroactive denials may be avoided if care is preauthorized;

     (6)  Procedures whereby private insurers may publicly release prior authorization data, disaggregated by drug or service, as it relates to approvals, denials, appeals, wait times, and other categories;

     (7)  Reasonable and appropriate periods of time for a new health plan to honor a patient's prior authorization for a transitional period of time; and

     (8)  Criteria or factors that would allow for a reduction in the total volume of prior authorization requests, such as exemptions or gold-carding programs; and

     BE IT FURTHER RESOLVED that the working group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and

     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, Chair of the Senate Standing Committee on Health and Human Services, Chair of the House of Representatives Standing Committee on Health, Administrator of the Med-QUEST Division of the Department of Human Services, Chairperson of the Board of Trustees of the Employer-Union Health Benefits Trust Fund, Chief Executive Officer of the Hawaii Medical Service Association, President of the Hawaii Medical Association, President of the Hawaii Association of Health Plans, Chief Executive Officer of the Healthcare Association of Hawaii, Director of the Center for Nursing, and Chief Executive Officer of Papa Ola Lokahi.

Report Title:

DHS; Health Insurance Reform; Prior Authorization; Working Group; Report

SENATE CONCURRENT

RESOLUTION

urging the director of health to establish a working group on HEALTH INSURANCE reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of healthcare in the state.

WHEREAS, although health insurance providers' prior authorization requirements are intended to ensure that medical services are necessary, cost-effective, and eligible for coverage, these requirements can cause critical medical treatments and tests to be delayed; and

WHEREAS, the misapplication of prior authorization requirements can be especially harmful for rural and medically underserved patients, who already face significant barriers to accessing care; and

     WHEREAS, the requirements can also create undue administrative burdens for healthcare providers, including providers in medically underserved areas; and

     WHEREAS, the Centers for Medicare and Medicaid Services have mandated changes to prior authorization rules that will help reduce the burdens of prior authorization on certain patients and physicians; and

     WHEREAS, whereas these changes do not benefit private payers in the State, who still require prior authorization for many common services; and

     WHEREAS, recommendations are needed to reduce the impact of prior authorization requirements on the delivery of healthcare to all patients in the State; now, therefore,

     BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Director of Health is urged to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of healthcare in the State; and

     BE IT FURTHER RESOLVED that the working group is requested to comprise:

     (1)  The Director of Health, or the Director's designee;

     (2)  The Chairperson of the Senate Committee on Health and Human Services, or a member appointed by the President of the Senate;

     (3)  The Chairperson of the House of Representatives Committee on Health, or a member appointed by the Speaker of the House of Representatives;

     (4)  A representative of the Hawaii Medical Service Association, to be selected and invited to participate by the Director of Health;

     (5)  The Department of Human Services' Med-QUEST Division Administrator, or the Administrator's designee;

     (6)  A member of the Hawaii Medical Association, to be selected and invited to participate by the Director of Health; and

     (7)         members who practice as family physicians in the State, to be selected and invited to participate by the Director of Health; and

     BE IT FURTHER RESOLVED that the working group is requested to consider all relevant federal law, Hawaii law, and law in other states to determine whether there are statutes and regulations that establish:

     (1)  Reasonable and appropriate prior authorization response times, including whether a response time of twenty-four hours for urgent care and forty-eight hours for non-urgent care is feasible;

     (2)  Valid prior authorizations for medications for a period of at least one year, regardless of dosage changes;

     (3)  Valid prior authorizations for the length of treatment for patients having chronic conditions;

     (4)  That adverse determinations should only be conducted by providers licensed in the State and of the same specialty that typically manages the patient's conditions;

     (5)  The manner in which retroactive denials may be avoided if care is preauthorized;

     (6)  Procedures whereby private insurers may publicly release prior authorization data, disaggregated by drug or service, as it relates to approvals, denials, appeals, wait times, and other categories;

     (7)  Reasonable and appropriate periods of time for a new health plan to honor a patient's prior authorization for a transitional period of time; and

     (8)  Criteria or factors that would allow for a reduction in the total volume of prior authorization requests, such as exemptions or gold-carding programs; and

     BE IT FURTHER RESOLVED that the working group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and

     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, Med-QUEST Division Administrator, Chief Executive Officer of the Hawaii Medical Service Association, and President of the Hawaii Medical Association.

Report Title:

DHS; Health Insurance Reform; Prior Authorization; Working Group; Report

STAND. COM. REP. NO. 1592

Honolulu, Hawaii

RE:    S.C.R. No. 10

       S.D. 2

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

     Your Committee on Commerce and Consumer Protection, to which was referred S.C.R. No. 10, S.D. 1, entitled:

"SENATE CONCURRENT RESOLUTION URGING THE DIRECTOR OF HEALTH TO ESTABLISH A WORKING GROUP ON HEALTH INSURANCE REFORM TO PROVIDE RECOMMENDATIONS FOR REDUCING THE IMPACT OF PRIOR AUTHORIZATION REQUIREMENTS ON THE TIMELY DELIVERY OF HEALTH CARE IN THE STATE,"

begs leave to report as follows:

     The purpose and intent of this measure is to urge the Director of Health to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the State.

     Your Committee received testimony in support of this measure from the State Health Planning and Development Agency, Hawaiʻi Primary Care Association, Hawaii Medical Association, Hawaii Association of Health Plans, Hawaii Medical Service Association, AlohaCare, and one individual.

     Your Committee finds that current prior authorization requirements utilized by insurers and managed care plans have greatly diminished the provision of essential services to patients on a timely basis.  This has negatively impacted the health care outcomes of the most vulnerable populations in the State.  Your Committee also finds that while recent changes in the federal Centers for Medicare and Medicaid services regarding prior authorization will greatly improve the prior authorization process for patients in federal programs, much more work is needed at the state level to ensure broader relief from the problems associated with the prior authorization process.  Your Committee believes that convening a panel of stakeholders to further examine this issue would be beneficial to identifying ways of improving the health care system for the State's residents.

     Your Committee further finds that Senate Bill No. 1449 and House Bill No. 250, introduced in the Regular Session of 2025, are similar measures that also establish a working group to make recommendations regarding the prior authorization process.  However, rather than the Director of Health convening the working group, these measures establish the working group in the State Health Planning and Development Agency (SHPDA), which administers the Certificate of Need Program, implements the Health Services and Facilities Plan, and promotes the sharing of facilities or services by health care providers to achieve economies of scale and restrict unusually costly services.  According to testimony received by your Committee, SHPDA is ready and able to convene the working group proposed in this measure and your Committee further finds that, by requesting the Director of Health, Med-QUEST Administrator, and the Insurance Commissioner to serve as ex-officio participants of the working group, this measure can lead to constructive results to reduce the impact of prior authorization requirements to improve the delivery of health care in the State.  Amendments to this measure are therefore necessary to address these recommendations.

     Accordingly, your Committee has amended this measure by:

     (1)  Requesting the Administrator of SHPDA, rather than the Director of Health, to convene the working group;

     (2)  Amending the membership of the working group;

     (3)  Amending its title accordingly; and

     (4)  Amending the list of individuals to whom certified copies of this measure are requested to be transmitted.

     As affirmed by the record of votes of the members of your Committee on Commerce and Consumer Protection that is attached to this report, your Committee concurs with the intent and purpose of S.C.R. No. 10, S.D. 1, as amended herein, and recommends its adoption in the form attached hereto as S.C.R. No. 10, S.D. 2.

Respectfully submitted on behalf of the members of the Committee on Commerce and Consumer Protection,

STAND. COM. REP. NO. 1199

Honolulu, Hawaii

RE:    S.C.R. No. 10

       S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

     Your Committee on Health and Human Services, to which was referred S.C.R. No. 10 entitled:

"SENATE CONCURRENT RESOLUTION URGING THE DIRECTOR OF HEALTH TO ESTABLISH A WORKING GROUP ON HEALTH INSURANCE REFORM TO PROVIDE RECOMMENDATIONS FOR REDUCING THE IMPACT OF PRIOR AUTHORIZATION REQUIREMENTS ON THE TIMELY DELIVERY OF HEALTHCARE IN THE STATE,"

begs leave to report as follows:

     The purpose and intent of this measure is to urge the Director of Health to establish a working group on health insurance reform to provide recommendations for reducing the impact of prior authorization requirements on the timely delivery of health care in the State.

     Your Committee received testimony in support of this measure from the Department of Health, State Health Planning and Development Agency, Hawaii Primary Care Association, Hawaii Medical Association, Hawaii Medical Service Association, and three individuals.

     Your Committee received comments on this measure from the Department of Human Services, Kaiser Permanente Hawaiʻi, and Hawaii Association of Health Plans.

     Your Committee finds that prior authorization is a process where a health care provider must get approval from a health insurance plan before providing certain medical services or prescriptions to a patient, ensuring that the treatment is deemed medically necessary and covered by the patient's health insurance plan.  However, your Committee further finds that prior authorization in the State has become increasingly complex and opaque, causing delays in patient care, increasing administrative burdens, and eroding public trust in the health care system, as the process places cost saving ahead of optimal patient care.  This measure convenes a working group to initiate collaborative conversations to mitigate the adverse impact of prior authorization in the State.

     Your Committee has amended this measure by:

     (1)  Deleting language that would have included the following as members of the working group on health insurance reform:

          (A)  A representative of the Hawaii Medical Service Association, to be selected and invited to participate by the Director of Health;

          (B)  A member of the Hawaii Medical Association, to be selected and invited to participate by the Director of Health; and

          (C)  An unspecified number of members who practice as family physicians in the State, to be selected and invited to participate by the Director of Health;

     (2)  Inserting language to include the following as members of the working group on health insurance reform:

          (A)  Five members representing the health insurance industry, to be selected by the Hawaii Association of Health Plans and invited by the Director of Health to participate;

          (B)  Five members representing licensed health care professionals, two of whom shall be selected by the Hawaii Medical Association, two of whom shall be selected by the Healthcare Association of Hawaii, and one of whom shall be selected by the Center for Nursing, to be invited by the Director of Health to participate; and

          (C)  Five members representing consumers of health care or employers, two of whom shall be selected by the board of trustees of the Employer-Union Health Benefits Trust Fund, one of whom shall be a consumer selected by the Statewide Health Coordinating Council, one of whom shall be selected by the Hawaii Primary Care Association, and one of whom shall be selected by Papa Ola Lokahi, to be invited by the Director of Health to participate; and

     (3)  Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

     Your Committee notes that H.B. No. 250, H.D. 2, Regular Session of 2025, passed by the House of Representatives, similarly proposes to establish a working group to collaborate on prior authorization reform.  Your Committee further notes that the working group proposed in H.B. No. 250, H.D. 2, comprises members similar to the members of the working group proposed in this measure, as amended.  Accordingly, if H.B. No. 250, H.D.2 is enacted, this measure will no longer be necessary.

     As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee concurs with the intent and purpose of S.C.R. No. 10, as amended herein, and recommends that it be referred to your Committee on Commerce and Consumer Protection, in the form attached hereto as S.C.R. No. 10, S.D. 1.

Respectfully submitted on behalf of the members of the Committee on Health and Human Services,