Bill Text: HI HB2362 | 2012 | Regular Session | Introduced
Bill Title: External Review; Managed Care Plans
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced - Dead) 2012-01-25 - (H) Referred to HLT, CPC/JUD, FIN, referral sheet 7 [HB2362 Detail]
Download: Hawaii-2012-HB2362-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
2362 |
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TWENTY-SIXTH LEGISLATURE, 2012 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to external review.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 432E, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432E- External review; appeals. (a) An enrollee or the enrollee's appointed representative may appeal the decision of an independent review organization and request an evidentiary hearing by filing a notice of appeal with the commissioner within thirty days of the date of the decision. The commissioner, at the commissioner's discretion, shall refer the appeal to:
(1) The circuit court, as provided for contested case appeals pursuant to section 91-14, in which case the appeal shall proceed according to the calendar set by the court, and further judicial review of the court's decision shall be as provided by law; or
(2) An administrative hearing by a hearings officer designated by the commissioner, or a review panel composed of a hearings officer and:
(A) A representative from a managed care plan that is not involved in the complaint; and
(B) A person who is licensed under chapter 453 to practice medicine in Hawaii, is currently practicing medicine in Hawaii, and is not involved in the complaint,
in which case the appeal shall be heard pursuant to title 16, chapter 201, of the Hawaii administrative rules and such other rules as the commissioner may adopt pursuant to chapter 91.
Upon a decision by the hearings officer or, if applicable, a majority vote of the review panel, the commissioner shall issue an order affirming, modifying, or reversing the decision of the independent review organization within thirty days of the hearing.
(b) No person shall serve as a hearings officer or on the review panel who, through a familial relationship within the second degree of consanguinity or affinity, or for other reasons, has a direct and substantial professional, financial, or personal interest in:
(1) The managed care plan involved in the complaint, including an officer, director, or employee of the plan; or
(2) The treatment of the enrollee, including but not limited to the developer or manufacturer of the principal drug, device, procedure, or other therapy at issue.
(c) No hearings officer or member of a review panel shall be liable in damages to any person for any opinions rendered or acts or omissions performed within the scope of the person's duties under the law during or upon completion of an appeal conducted pursuant to this section, unless the opinion was rendered or the act or omission was performed in bad faith or involved gross negligence.
(d) An enrollee may be allowed, at the commissioner's discretion, an award of a reasonable sum for attorney's fees, reasonable costs, and expert fees incurred in connection with an appeal under this section, unless the commissioner in a separate administrative proceeding determines that the appeal was unreasonable, fraudulent, excessive, or frivolous.
(e) The enrollee may request an expedited appeal, in which case the appeal shall be heard by at least one person identified in subsection (a)(2). A decision in an expedited appeal shall be rendered as expeditiously as possible but in no event more than seven days after the date the commissioner received the request.
(f) A decision of a hearings officer or review panel regarding the enrollee's appeal shall be appealable to the intermediate appellate court, as provided in section 602-57."
SECTION 2. New statutory material is underscored.
SECTION 3. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
External Review; Managed Care Plans
Description:
Allows an enrollee in a managed care plan or the enrollee's appointed representative to appeal an external review decision issued under chapter 432E, Hawaii Revised Statutes, to the circuit court, hearings officer, or review panel.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
