HRS §431:26-107
State insurance chief can enforce health network rules
If the insurance commissioner finds a health plan does not have enough doctors or other providers, or breaks network rules, the commissioner can make the plan fix it. The commissioner can require changes, a corrective plan, or use other powers. The commissioner will not settle disputes between plans and providers.
The statute, as written — Enforcement
(a) If the commissioner determines that: (1) A health carrier has not contracted with a sufficient number of participating providers to ensure that covered persons have accessible health care services in a geographic area; (2) A health carrier's network access plan does not ensure reasonable access to covered benefits; (3) A health carrier has entered into a contract that does not comply with this article; or (4) A health carrier has not complied with this article, then the commissioner shall require a modification to the access plan, institute a corrective action plan that shall be followed by the health carrier, or use any of the commissioner's other enforcement powers to obtain the health carrier's compliance with this article. (b) The commissioner shall not arbitrate, mediate, or settle disputes regarding a decision not to include a provider in a network plan or provider network or regarding any other dispute between a health carrier, its intermediaries, or one or more providers arising under a provider contract or its termination.
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