January 1, 2020, with additional alignment to the federal No Surprises Act (NSA) in 2022.

Hawaii (Hawaii) implemented statewide protections against surprise medical billing prior to the NSA, focusing on emergency care and unintentional out-of-network (OON) encounters. The state provides a strong consumer protection framework but does not maintain its own out-of-network payment benchmark or independent arbitration systemrecognized by CMS.

As a result, Hawaii relies on the Federal NSA Independent Dispute Resolution (IDR) process for resolving OON payment disputes.

Hawaii law protects patients who unintentionally receive care from an OON provider. Under its statutory framework:

• Patients cannot be charged more than their in-network cost-sharing amount for covered emergency OON services or for OON services delivered at an in-network facility.
• Providers must submit claims directly to the health carrier, not the patient.
• Insurers must issue an initial payment that reflects a reasonable, market-based methodology, consistent with state insurance standards.

Hawaii does not require the use of an APCD, a UCR formula, or a state-defined benchmark.
After January 1, 2022, most eligible claims defaulted to the federal QPA structure under the NSA.

Hawaii does not operate its own state-run arbitration or dispute resolution process specific to surprise billing disputes.

Therefore:

• Hawaii does not have a “Specified State Law (SSL)” for determining OON rates.
• All applicable disputes must be resolved through Federal NSA IDR.
• Providers and insurers follow the NSA process for emergency OON, in-facility OON, and air ambulance claims.

There is no Hawaii-based arbitration option for commercial plans.

Hawaii uses the federal negotiation and arbitration timeline, including:

• A 30-day open negotiation period following the insurer’s initial payment or denial.
• If unresolved, either party may initiate arbitration through the federal IDR portal.

Hawaii does not impose additional timeline or process requirements beyond federal law.

Since Hawaii relies on the federal NSA system, arbitrators evaluate the federal statutory criteria, including:

• Qualified Payment Amount (QPA) — primary benchmark
• Provider experience, training, and the complexity of the case
• Past contracted rates (within four years)
• Market share of provider or plan
• Good-faith contracting attempts
• Clinical complexity or facility-level factors

Hawaii does not introduce separate state-specific arbitration standards.

Hawaii’s surprise billing and insurance protections derive from:

• HRS § 432E – Long-standing patient rights & insurance protections
• Hawaii Insurance Division regulatory guidance
• Adoption of federal NSA requirements under 45 CFR 149.510 & 149.520

These statutes protect patients from inappropriate balance billing but do not establish a state-defined OON payment methodology.

CMS has determined that Hawaii does not maintain a Specified State Law (SSL) for OON payment determination.

• Fully insured commercial plans
• Individual health insurance policies
• Group health insurance coverage
• Self-funded ERISA plans (unless adopting an SSL, which is extremely rare)

• The QPA governs payment determinations for eligible OON claims.
• All eligible disputes must proceed through Federal NSA IDR.
• Hawaii carriers must comply with NSA payment deadlines, QPA disclosures, and negotiation rules.
• Hawaii state law strengthens consumer protections but does not replace the federal arbitration structure.