SENATE DOCKET, NO. 880        FILED ON: 1/15/2025

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No.         

The Commonwealth of Massachusetts

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PRESENTED BY:

John J. Cronin

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act streamlining the prior authorization process.

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PETITION OF:

SENATE DOCKET, NO. 880        FILED ON: 1/15/2025

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No.         

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Fourth General Court
(2025-2026)

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An Act streamlining the prior authorization process.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

Notwithstanding any special or general law to the contrary, the commissioner of insurance shall develop a list of services that are appropriate for real-time automated approvals of prior authorization requests of covered services when the clinical information submitted electronically by a provider clearly establishes that the patient meets the medical necessity criteria for the requested service. In developing the list, the commissioner shall seek input from the Massachusetts Collaborative and other interested stakeholders, and focus on services with high prior authorization approval rates and clearly established clinical treatment protocols. The division of insurance shall publish the list on its website not later than January 1, 2027. Carriers that require prior authorization for services on the published list shall implement an automated process for the real-time approval of covered services that clearly meet medical necessity criteria not later than January 1, 2028.