Mass. health providers, patient advocates urge fast, standardized prior-authorization rules in hearing on H.1136

BOSTON — Dozens of doctors, hospital administrators and patient advocates told members of the Joint Committee on Financial Services and Insurance on Tuesday that prior-authorization rules used by insurers are delaying medically necessary care and creating heavy administrative costs, and they urged lawmakers to approve H.1136 to standardize and speed the process.

The bill would keep prior authorization as a utilization-management tool but require faster responses for urgent requests, require insurers to publish which services need prior authorization and create continuity rules when patients switch plans. "Prior authorization unnecessarily delays and denies access to medically necessary care for patients, and also the costly administrative waste that it creates in our health care system," said Lita Anderson, director of advocacy and government relations for the Massachusetts Medical Society.

Supporters said lengthy, inconsistent reviews force health systems and practices to hire staff devoted to authorizations and contribute to clinician burnout. Karen Granoff, senior director of managed care policy for the Massachusetts Health and Hospital Association, said slow insurer responses can keep patients in hospital beds while staff wait for placement in post-acute settings. "Insurance issues…