HRS §323D-19
Reporting health care prior authorization data
Companies that review health care requests in Hawaii must send data about prior authorizations to the state agency every year. The agency posts the report format and a summary of findings online. Private health information is protected unless the person agrees or the law allows it.
state agencies
The statute, as written — Prior authorization data; reporting
(a) Utilization review entities doing business in the State shall submit data to the state agency relating to prior authorization of health care services, in a format specified by the state agency. Reporting shall be annual for the preceding calendar year and shall be submitted no later than January 31 of the subsequent calendar year. The state agency shall post the format for reporting on its website no later than three months before the start of the reporting period. (b) Protected health information as defined in title 45 Code of Federal Regulations section 160.103 shall not be submitted to the state agency unless: (1) The individual to whom the information relates authorizes the disclosure; or (2) Authorization is not required pursuant to title 45 Code of Federal Regulations section 164.512. (c) The state agency shall compile the prior authorization data by provider of health insurance, health care setting, and line of business, and shall post a report of findings, including recommendations, on its website no later than March 1 of the year after the reporting period. If the state agency is unable to post the report of findings by March 1, the state agency shall notify the legislature in writing within ten days and include an estimated date of posting, reasons for the delay, and if applicable, a corrective action plan.
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