§431M-6  Rules.  The insurancecommissioner, after consultation with all interested parties including thedirector of health, the Hawaii medical board, the board of psychology, andrepresentatives 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 asare deemed necessary for the effective implementation and operation of thischapter.  The rules shall include criteria and guidelines to be used indetermining the appropriateness and medical or psychological necessity ofservices covered under this chapter, including the appropriate level of care orplace of treatment and the number or quantity of services, and the objectiveand quantifiable criteria for determining when a health maintenanceorganization meets the conditions and requirements of section 431M-5, and shallinclude an appeals process.

The director of health shall also adopt rulespursuant to chapter 91 as are deemed necessary for the implementation andoperation of this chapter.  The rules shall provide certification standardsthat:

(1)  Reflect quality of care; and

(2)  Do not compromise the quality of care. [L 1988, c202, 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]