§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]