H4616
An Act improving the health insurance prior authorization process
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- Passed House
- Passed Senate
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Bill overview
This bill aims to streamline and improve the process for health insurance companies to require prior authorization for medical treatments and medications. Currently, the process can be lengthy and confusing for both patients and providers. The bill seeks to increase transparency and reduce delays in obtaining these authorizations, ultimately aiming to improve patient access to necessary care. It intends to create a more efficient and predictable system for prior authorization requests.
Key provisions
- Requires health insurers to provide clear and standardized prior authorization forms.
- Establishes timelines for insurers to respond to prior authorization requests.
- Mandates that insurers notify patients and providers of the reason for a prior authorization denial.
- Requires insurers to provide a process for patients to appeal prior authorization denials.
- Promotes the use of electronic prior authorization systems.
- Creates a process for reporting data on prior authorization requests and denials.
- Requires insurers to provide a written explanation for denials.
- Establishes a process for expedited prior authorization for urgent medical needs.
Who is affected
- Patients
- Healthcare Providers
- Health Insurance Companies
- Medicaid Managed Care Organizations
- The Health Care Financing Committee
Notable changes
- The bill seeks to standardize the prior authorization process across different insurance plans in Massachusetts.
Sponsors
Official sponsors from legislative records.
Primary sponsor
Joint Committee on Financial Services
Cosponsors
Adam J. Scanlon
Amy Mah Sangiolo
Carmine Lawrence Gentile
Danillo A. Sena
Arguments in favor
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Bill H.4616 194th (Current)
An Act improving the health insurance prior authorization process
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Bill Information
Bill Information
Sponsor: Joint Committee on Financial Services Status: Referred to Joint Committee on Health Care Financing
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Bill History Cosponsors Committee Vote Committee Summary
Bill History
Displaying 5 actions for Bill H.4616
| Date | Branch | Action |
| 10/20/2025 | House | Reported from the committee on Financial Services |
| 10/20/2025 | House | New draft of H1136 |
| 10/20/2025 | House | Reported favorably by committee and referred to the committee on Health Care Financing |
| 12/8/2025 | House | Reporting date extended to Wednesday, March 18, 2026 |
| 3/19/2026 | House | Reporting date extended to Monday, June 15, 2026 |
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