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| 2 | 2 | | SENATE DOCKET, NO. 880 FILED ON: 1/15/2025 |
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| 3 | 3 | | SENATE . . . . . . . . . . . . . . No. 706 |
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| 4 | 4 | | The Commonwealth of Massachusetts |
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| 5 | 5 | | _________________ |
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| 6 | 6 | | PRESENTED BY: |
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| 7 | 7 | | John J. Cronin |
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| 8 | 8 | | _________________ |
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| 9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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| 10 | 10 | | Court assembled: |
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| 11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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| 12 | 12 | | An Act streamlining the prior authorization process. |
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| 13 | 13 | | _______________ |
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| 14 | 14 | | PETITION OF: |
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| 15 | 15 | | NAME:DISTRICT/ADDRESS :John J. CroninWorcester and Middlesex 1 of 1 |
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| 16 | 16 | | SENATE DOCKET, NO. 880 FILED ON: 1/15/2025 |
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| 17 | 17 | | SENATE . . . . . . . . . . . . . . No. 706 |
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| 18 | 18 | | By Mr. Cronin, a petition (accompanied by bill, Senate, No. 706) of John J. Cronin for |
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| 19 | 19 | | legislation to streamline the prior authorization process for covered health care services. |
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| 20 | 20 | | Financial Services. |
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| 21 | 21 | | The Commonwealth of Massachusetts |
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| 22 | 22 | | _______________ |
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| 23 | 23 | | In the One Hundred and Ninety-Fourth General Court |
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| 24 | 24 | | (2025-2026) |
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| 25 | 25 | | _______________ |
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| 26 | 26 | | An Act streamlining the prior authorization process. |
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| 27 | 27 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 28 | 28 | | of the same, as follows: |
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| 29 | 29 | | 1 Notwithstanding any special or general law to the contrary, the commissioner of |
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| 30 | 30 | | 2insurance shall develop a list of services that are appropriate for real-time automated approvals |
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| 31 | 31 | | 3of prior authorization requests of covered services when the clinical information submitted |
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| 32 | 32 | | 4electronically by a provider clearly establishes that the patient meets the medical necessity |
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| 33 | 33 | | 5criteria for the requested service. In developing the list, the commissioner shall seek input from |
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| 34 | 34 | | 6the Massachusetts Collaborative and other interested stakeholders, and focus on services with |
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| 35 | 35 | | 7high prior authorization approval rates and clearly established clinical treatment protocols. The |
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| 36 | 36 | | 8division of insurance shall publish the list on its website not later than January 1, 2027. Carriers |
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| 37 | 37 | | 9that require prior authorization for services on the published list shall implement an automated |
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| 38 | 38 | | 10process for the real-time approval of covered services that clearly meet medical necessity criteria |
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| 39 | 39 | | 11not later than January 1, 2028. |
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