§431M-6 - Rules. - Hawaii Statutes

     §431M-6  Rules.  The insurance commissioner, after consultation with all interested parties including the director of health, the Hawaii medical board, the board of psychology, and representatives of insurance carriers, nonprofit mutual benefit societies, health maintenance organizations, public and private providers, consumers, employers, and labor organizations shall adopt rules pursuant to chapter 91 as are deemed necessary for the effective implementation and operation of this chapter.  The rules shall include criteria and guidelines to be used in determining the appropriateness and medical or psychological necessity of services covered under this chapter, including the appropriate level of care or place of treatment and the number or quantity of services, and the objective and quantifiable criteria for determining when a health maintenance organization meets the conditions and requirements of section 431M-5, and shall include an appeals process.

     The director of health shall also adopt rules pursuant to chapter 91 as are deemed necessary for the implementation and operation of this chapter.  The rules shall provide certification standards that:

     (1)  Reflect quality of care; and

     (2)  Do not compromise the quality of care. [L 1988, c 202, pt of §1, §3; am L 1991, c 90, §2; am L 1994, c 111, §4; am L 1998, c 78, §3; am L 2002, c 239, §1; am L 2004, c 122, §83; am L 2008, c 9, §3]