Chapter 432E — Chapter 432E
14 sections in this chapter.
HRS §432E-1 Definitions
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PART I. GENERAL PROVISIONS §432E-1 Definitions. As used in this chapter, unless the context otherwise requires: "Adverse action" means an adverse determination or a final adverse determination. "Adverse determination" means a determination by a health carrier or its designated ut…
HRS §432E-1.4 Medical necessity
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§432E-1.4 Medical necessity. (a) For contractual purposes, a health intervention shall be covered if it is an otherwise covered category of service, not specifically excluded, recommended by the treating licensed health care provider, and determined by the health plan's medical d…
HRS §432E-1.5 Licensure of managed care plan medical directors
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§432E-1.5 Licensure of managed care plan medical directors. The medical director of any managed care plan providing services in the State shall hold an unlimited license to practice medicine or osteopathic medicine in the State pursuant to chapter 453. [L 1999, c 273, §1; am L 20…
HRS §432E-10 Managed care plan performance measurement and data reporting standards
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§432E-10 Managed care plan performance measurement and data reporting standards. (a) It is the policy of this State that all managed care plans shall adopt and comply with nationally developed and promulgated standards for measuring quality, outcomes, access, satisfaction, and ut…
HRS §432E-11 Accreditation of managed care plans
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§432E-11 Accreditation of managed care plans. (a) Beginning January 1, 1999, the commissioner shall contract with one or more certified vendors of the consumer assessment health plan survey to conduct a survey of all managed care plans actively offering managed care plans in this…
HRS §432E-3 REPEALED
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PART II. GENERAL POLICIES §432E-3 REPEALED. L 2013, c 192, §5.
HRS §432E-34 Standard external review
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§432E-34 Standard external review. (a) An enrollee or the enrollee's appointed representative may file a request for an external review with the commissioner within one hundred thirty days of receipt of notice of an adverse action. Within three business days after the receipt of …
HRS §432E-35 Expedited external review
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§432E-35 Expedited external review. (a) Except as provided in subsection (i), an enrollee or the enrollee's appointed representative may request an expedited external review with the commissioner if the enrollee receives: (b) Upon receipt of a request for an expedited external re…
HRS §432E-36 External review of experimental or investigational treatment adverse determinations
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§432E-36 External review of experimental or investigational treatment adverse determinations. (a) An enrollee or an enrollee's appointed representative may file a request for an external review with the commissioner within one hundred thirty days of receipt of notice of an advers…
HRS §432E-4 Enrollee participation in treatment decisions
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§432E-4 Enrollee participation in treatment decisions. (a) An enrollee shall have the right to be informed fully prior to making any decision about any treatment, benefit, or nontreatment. (b) In order to inform enrollees fully, the provider shall: (c) The provider shall discuss …
HRS §432E-5 Complaints and appeals procedure for enrollees
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§432E-5 Complaints and appeals procedure for enrollees. (a) A health carrier with enrollees in this State shall establish and maintain a procedure to provide for the resolution of an enrollee's complaints and internal appeals. The procedure shall provide for expedited internal ap…
HRS §432E-6 REPEALED
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§432E-6 REPEALED. L 2011, c 230, §10.
HRS §432E-6.5 Expedited internal appeal, when authorized; standard for decision
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§432E-6.5 Expedited internal appeal, when authorized; standard for decision. (a) An enrollee may request that the internal appeal under section 432E-5 be conducted as an expedited appeal. If a request for expedited appeal is approved by the health carrier, the appropriate interna…
HRS §432E-7 Information to enrollees
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§432E-7 Information to enrollees. (a) The managed care plan shall provide to its enrollees upon enrollment and thereafter upon request the following information: This information shall be provided to prospective enrollees upon request. (b) Every managed care plan shall provide to…