Chapter 432E

Patients' Bill of Rights and Responsibilities Act

CHAPTER 432E

[PATIENTS’ BILL OF RIGHTS AND RESPONSIBILITIES ACT]

Part I. General Provisions

Section

432E-1 Definitions

432E-1.4 Medical necessity

432E-1.5 Licensure of managed care plan medical directors

432E-2 Conflict with other laws

Part II. General Policies

432E-3 Repealed

432E-4 Enrollee participation in treatment decisions

432E-5 Complaints and appeals procedure for enrollees

432E-6 Repealed

432E-6.5 Expedited internal appeal, when authorized;

standard for decision

432E-7 Information to enrollees

432E-8 Enforcement

Part III. Reporting and Other Provisions

432E-9 Utilization review

432E-10 Managed care plan performance measurement and

data reporting standards

432E-11 Accreditation of managed care plans

432E-12 Rules

432E-13 Annual report

Part IV. External Review of Health Insurance

Determinations

432E-31 Applicability and scope

432E-32 Notice of right to external review

432E-33 Request for external review

432E-34 Standard external review

432E-35 Expedited external review

432E-36 External review of experimental or

investigational treatment adverse

determinations

432E-37 Binding nature of external review decision

432E-38 Approval of independent review organizations

432E-39 Minimum qualifications for independent review

organizations

432E-40 Hold harmless for independent review

organizations

432E-41 External review reporting requirements

432E-42 Funding of external review

432E-43 Disclosure requirements

432E-44 Rules

Note

The amendments made to this chapter by L 2011, c 230 have a transitional effective date and are subject to the insurance commissioner’s emergency rulemaking authority for conformance to the federal Patient Protection and Affordable Care Act and a conditional repeal and reenactment provision. L 2011, c 230, §§14, 17.

Cross References

Health care provider network adequacy, see chapter 432F.

Law Journals and Reviews

Hawai‘i’s Patients’ Bill of Rights: Saving the Right to External Review. 28 UH L. Rev. 295 (2005).

Case Notes

As chapter 432D does not cover the field of managed care regulation and because §§432D-2, 432E-1, and article 431:10A can be read together and there is no explicit language or policy reason not to give each statute effect, chapter 432D does not repeal this chapter by implication. 126 H. 326, 271 P.3d 621 (2012).