An Act improving the health insurance prior authorization process
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
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
Bill text
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Sponsors
Official sponsors from legislative records.
27 on record
Primary sponsor
Joint Committee on Financial Services
Cosponsors
Amy Mah Sangiolo
Carmine Lawrence Gentile
Danillo A. Sena
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