Massachusetts House Bill H1136

Massachusetts 2025-2026 Regular Session

• Introduced: 2/27/25
• Refer: 2/27/25

Caption

Improving the health insurance prior authorization process

Impact

If enacted, H1136 will significantly influence Massachusetts's health insurance regulations by enforcing that carriers cannot request prior authorization for non-listed items or services, which may reduce administrative burdens on healthcare providers. The bill also calls for the establishment of a task force to analyze the implications of prior authorization on healthcare costs and access, which could lead to changes in the state's approach to health insurance management. This task force will focus on identifying services with low denial rates that could benefit from the elimination of prior authorization requirements, thereby enhancing patient access to necessary care.

Summary

House Bill H1136, titled 'An Act Improving the Health Insurance Prior Authorization Process,' seeks to reform and streamline the procedures surrounding the prior authorization process required by health insurance carriers. The bill mandates all licensed carriers to maintain a publicly accessible list of items, services, and medications requiring prior authorization, thereby minimizing arbitrary denials for services not listed. This initiative aims to simplify and standardize prior authorization procedures across the health insurance landscape, making health care services more accessible and ensuring that patients receive timely treatments.

Contention

Discussion around H1136 has highlighted concerns regarding the balance between necessary oversight and access to care. Proponents argue that eliminating unnecessary prior authorization will enhance the efficiency of the healthcare system and improve patient outcomes, while critics express concerns over potential regulatory challenges and the necessity of maintaining some level of control to prevent misuse of health services. Special attention is also drawn to the potential role of artificial intelligence in the decision-making process for prior authorization, wherein regulations will require decisions to be made by qualified healthcare professionals rather than solely algorithm-driven processes.