Note
Sections 432E-9 through 432E-13 designated as Part III by L 2011, c 230, §5.
§432E-9 Utilization review. (a) Every managed care plan shall establish procedures for continuous review of quality of care, performance of providers, utilization of health services, facilities, and costs.
(b) Notwithstanding any other provision of law, there shall be no monetary liability on the part of, and no cause of action for damages shall arise against, any person who participates in quality of care or utilization reviews by peer review committees for any act performed during the reviews if the person acts without malice, makes a reasonable effort to obtain the facts, and believes that the action taken is warranted by the facts.
(c) No peer review committee under this section shall be subject to discovery, and no person in attendance at the reviews shall be required to testify as to what transpired at the reviews. The utilization review requirements and administrative treatment guidelines of the health maintenance organization shall not fall below the appropriate standard of care and shall not impinge upon the independent medical judgment of the treating health care provider.
(d) Nothing in this section shall be construed to prevent a health maintenance organization from conducting a utilization review and quality assurance program. [L 1998, c 178, pt of §2]
Structure Hawaii Revised Statutes
432E. Patients' Bill of Rights and Responsibilities Act
432E-1.5 Licensure of managed care plan medical directors.
432E-2 Conflict with other laws.
432E-4 Enrollee participation in treatment decisions.
432E-5 Complaints and appeals procedure for enrollees.
432E-6.5 Expedited internal appeal, when authorized; standard for decision.
432E-7 Information to enrollees.
432E-10 Managed care plan performance measurement and data reporting standards.
432E-11 Accreditation of managed care plans.
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.