H 4616
An Act improving the health insurance prior authorization process
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- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to improve the process of obtaining prior authorization for medical treatments and medications from health insurance companies in Massachusetts. It requires insurers to publicly list services requiring prior authorization, mandates data reporting on authorization decisions, and establishes criteria for utilization review. The bill also seeks to streamline prior authorization requirements and create a task force to further examine and simplify the process.
Key provisions
- Requires all licensed health insurers to publicly list services requiring prior authorization on their websites.
- Mandates annual reporting by insurers and utilization review organizations on prior authorization approval and denial rates, along with response times.
- Establishes a task force to study prior authorization practices and recommend improvements.
- Sets standards for utilization review criteria, prioritizing scientifically derived and evidence-based approaches.
- Requires insurers to implement a standardized electronic interface for prior authorization requests.
- Prohibits retroactive denial of authorization for previously approved treatments unless fraudulent information is discovered.
- Creates a process for ensuring continuity of prior authorizations for stable patients.
- Requires insurers to notify patients of changes to prior authorization requirements.
Who is affected
- Health insurance carriers and utilization review organizations
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
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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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