(A) Without regard to chapter 76, retain an independent medical expert trained in the field of medicine most appropriately related to the matter under review[.] to conduct the external review. The review by the independent medical expert shall be limited to issues of medical necessity and coverage exclusions for experimental and investigational medical procedures. Presentation of evidence for this purpose shall be exempt from section 91-9(g)[; and]. The commissioner shall transfer the request for review and the submissions of the enrollee and the plan to the independent medical expert. The managed care plan that is the subject of the external review shall be responsible for paying the reasonable fee and costs of the independent medical expert selected by the commissioner. The independent medical expert shall submit an invoice for services and costs to the commissioner together with the expert's determination. The commissioner shall review the invoice for reasonableness and shall transmit the invoice to the managed care plan for payment by the managed care plan within thirty days of receipt. The selection and hiring of the independent medical expert by the commissioner shall not be subject to chapter 103D;

(B) [The services of] Select an independent review organization from an approved list maintained by the commissioner[;] to conduct the external review. The review by an independent review organization shall be limited to issues of medical necessity and coverage exclusions for experimental and investigational medical procedures. Presentation of evidence for this purpose shall be exempt from section 91-9(g). The commissioner shall transfer the request for review and the submissions of the enrollee and the plan to an independent review organization that has available to conduct the review, a medical expert trained in the field of medicine most appropriately related to the matter under review. The managed care plan that is the subject of the external review shall be responsible for paying the reasonable fee and costs of the independent review organization selected by the commissioner to conduct the review. The independent review organization shall submit its invoice for services and costs to the commissioner together with its determination. The commissioner shall review the invoice for reasonableness and shall transmit the invoice to the managed care plan for payment by the managed care plan within thirty days of receipt. The selection and hiring of the independent review organization by the commissioner shall not be subject to chapter 103D; or

(C) Upon determination that an employee benefit plan within Title 29 of the United States Code Section 1003(a) is not implicated, appoint the members of a three-member external review panel composed of a representative from a managed care plan not involved in the complaint, a provider licensed to practice and practicing medicine in Hawaii not involved in the complaint, and the commissioner or the commissioner's designee, to conduct the external review. The review panel shall conduct a hearing pursuant to chapter 91. If the amount in controversy is less than $1,000, the commissioner or the commissioner's designee may conduct a review hearing pursuant to chapter 91, without appointing a review panel. The commissioner shall make the determination whether Title 29 United States Code Section 1003(a) applies to the enrollee's plan within twenty days after receipt of the managed care plan's position, if any, on whether Title 29 United States Code Section 1003(a) applies to the enrollee's plan, and any other documents, information, or affidavits the commissioner shall require of the requestor or the managed care plan, and shall notify the managed care plan, the requestor, and the enrollee of the commissioner's determination. The notice to the enrollee shall provide a statement that the enrollee's request for external review shall be without prejudice to the enrollee's right to file a civil action in state or federal court for a determination of the enrollee's entitlement to benefits, and that the employee may have other rights, including the right to an award of reasonable attorney's fees and costs;

(A) Any documents or information related to or used in making the final internal determination, including the enrollee's medical records;

(B) Any documentation or written information submitted to the managed care plan in support of the enrollee's initial complaint; [and]

(C) A list of the names, addresses, and telephone numbers of each licensed health care provider who cared for the enrollee and who may have medical records relevant to the external review;

(D) An estimate of the amount in controversy; and

(E) The managed care plan's position, if any, on whether Title 29 United States Code Section 1003(a) applies to the enrollee's plan; provided that where an expedited appeal is involved, the managed care plan or its designee utilization review organization shall provide the documents and information within forty-eight hours of receipt of the request for external review.

Failure by the managed care plan or its designee utilization review organization to provide the documents and information within the prescribed time periods shall not delay the conduct of the external review. Where the plan or its designee utilization review organization fails to provide the documents and information within the prescribed time periods, the commissioner may issue a decision to reverse the final internal determination, in whole or part, and shall promptly notify the independent review organization, the enrollee, the enrollee's appointed representative, if applicable, the enrollee's treating provider, and the managed care plan of the decision;

(A) [The] In the case of a review by an independent medical expert pursuant to subsection (a)(2)(A) or by an independent review organization pursuant to subsection(a)(2)(B), the decision shall be made no later than sixty days after the date of the request for external review. In the case of a hearing by an external review panel or by the commissioner without a panel when the amount in controversy is less than $1,000, the hearing shall be held no later than sixty days from the date of the request for the hearing; and

(B) An external review conducted as an expedited appeal shall be determined no later than seventy-two hours after receipt of the request for external review;

(A) The terms of the agreement of the enrollee's insurance policy, evidence of coverage, or similar document;

(B) Whether the medical director properly applied the medical necessity criteria in section 432E-1.4 in making the final internal determination;

(C) All relevant medical records;

(D) The clinical standards of the plan;

(E) The information provided;

(F) The attending physician's recommendations; and

(G) Generally accepted practice guidelines[.];