SB2292

SECTION 1. The legislature finds that Hawaii employers pay among the highest workers' compensation premiums in the nation, due in part to unnecessary medical treatments prescribed for injured employees, including treatments not based on sound medical practices.

The legislature believes that adopting evidence-based treatment guidelines applicable to all worker's compensation cases will help to reduce insurer costs and insurance premiums.

The purpose of this Act is to establish standardized medical treatments for the purposes of preventing unnecessary procedures and ensuring consistent, high-quality care for injured employees.

SECTION 2. Chapter 386, Hawaii Revised Statutes, is amended by adding four new sections to subpart A of part II to be appropriately designated and to read as follows:

"§386-A Medical treatment utilization schedule; established. (a) The department shall adopt rules under chapter 91 establishing a medical treatment utilization schedule. Except as provided in sections 386-C and D, each attending physician shall use the medical treatment utilization schedule to determine the proper medical treatment for an injured employee.

(b) The medical treatment utilization schedule shall:

(1) Include medical treatment guidelines based on the principles of evidence-based medicine;

(2) Incorporate by reference the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines; and

(3) Specify any treatments that do not require preauthorization by the employer.

§386-B Medical treatment utilization schedule; presumption. The medical treatments in the medical treatment utilization schedule established under section 386-A shall be considered presumptively correct on the issue of the extent and scope of any necessary medical treatment shall constitute the standard for the provision of medical care in accordance with this chapter for all injured employees.

§386-C Medical evidence search sequence. (a) Each attending physician shall conduct the search sequence specified in this section to evaluate and determine the appropriate medical treatment for each injured employee.

(b) Subject to this section and section 386-D, each attending physician shall search the following sources, in the order specified below, for the recommended medical treatment:

(1) The medical treatment utilization schedule;

(2) The most current version of the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines;

(3) The most current version of the Official Disability Guidelines published by the Work-Loss Data Institute;

(4) The most current version of other evidence-based medical treatment guidelines that are nationally recognized by the medical community; and

(5) Current studies that are evidence-based, peer‑reviewed, and published in journals that are nationally recognized by the medical community.

(c) If the recommended medical treatment for the injured employee's medical condition or injury is addressed by the medical treatment utilization schedule under subsection (b)(1), the attending physician shall:

(1) Follow the recommendation specified in the medical treatment utilization schedule; or

(2) Challenge the medical treatment utilization schedule's presumption of correctness. The challenge shall follow the procedures established under section 386-D.

(d) If the recommended medical treatment for the injured employee's medical condition or injury is not addressed by the medical treatment utilization schedule under subsection (b)(1), the attending physician shall review the sources in subsection (b)(2) to (5) in the order listed and select the first applicable recommended treatment found; provided that any treatment found in the sources under subsections (b)(4) or (5) may be the consensus of the sources in that paragraph.

(e) Employers, at their discretion, may approve medical treatment additional to or different than the treatment recommended in the medical treatment utilization schedule or other listed sources to account for medical circumstances warranting an exception. The attending physician shall provide to the employer clear documentation of the clinical rationale for the variance focused on the expected objective functional gains afforded by the requested treatment and its impact on the injured employee's prognosis.

§386-D Challenge to medical treatment utilization schedule. (a) A challenge made under section 386-C(c)(2) shall follow the procedures established by this section.

(b) If a medical condition or injury is addressed by the medical treatment utilization schedule and the attending physician determines that a different treatment should be prescribed, the attending physician shall review the sources in section 386-C(b)(2) to (5) in the order listed and select the first applicable recommended treatment found; provided that any treatment found in the sources under section 386-C(b)(4) or (5) may be the consensus of the sources in that paragraph.

(c) The attending physician shall then inform the employer of the recommended treatment in a form provided by the department. The form shall include appropriate citations and shall explain the intended variance from the medical treatment utilization schedule. The attending physician shall bear the burden of proving, by a preponderance of scientific medical evidence, that a variance from the medical treatment utilization schedule is reasonably required to cure the injured employee or provide relief from the effects of the injury or condition.

(d) If a dispute arises between the attending physician and the employer regarding the appropriate treatment, the employee shall continue to receive essential medical services as required under section 386-21(c) and the director shall resolve any disputes in the manner specified under section 386-21(c)."

SECTION 3. Section 386-21.2, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) A physician may transmit a treatment plan to an employer by mail or facsimile; provided that the physician shall send the treatment plan to an address or facsimile number provided by the employer. The treatment plan shall be consistent with sections 386-A to D."

SECTION 4. Section 386-26, Hawaii Revised Statutes, is amended to read as follows:

"§386-26 [~~Guidelines on frequency of treatment and reasonable utilization of health care and services.~~] Medical fee schedules. The [director shall issue guidelines for the frequency of treatment and for reasonable utilization of medical care and services by health care providers that are considered necessary and appropriate under this chapter. The guidelines shall not be considered as an authoritative prescription for health care, nor shall they preclude any health care provider from drawing upon the health care provider's medical judgment and expertise in determining the most appropriate care.

~~The guidelines shall be adopted pursuant to chapter 91 and shall not interfere with the injured employee's rights to exercise free choice of physicians under section 386-21.~~

~~In addition, the~~] director shall adopt updated medical fee schedules referred to in section 386-21, and where deemed appropriate, shall establish separate fee schedules for services of health care providers as defined in section 386-1 [~~to become effective no later than June 30, 1986,~~] in accordance with chapter 91."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

INTRODUCED BY:

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THE SENATE	S.B. NO.	2292
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII