Mass. health-care providers urge overhaul of prior authorization rules to cut delays and costs

Lawmakers heard extended testimony Tuesday on H.1136, an act to improve the health-insurance prior-authorization process, with physicians, hospitals and consumer advocates asking for time limits, clearer lists of services that require authorization and rules to preserve treatment when patients change plans.

The bill would require faster insurer responses for urgent requests, standardize which services are subject to prior authorization, make prior authorizations valid for the length of treatment or at least one year, and create a transition period when patients switch plans so care is not interrupted.

Supporters said the current system delays care, creates administrative waste and contributes to clinician burnout. "Prior authorization unnecessarily delays and denies access to medically necessary care for patients, and it causes costly administrative waste," said Lita Anderson, director of advocacy and government relations for the Massachusetts Medical Society. Anderson told the committee prior authorization is the No. 1 issue members raise and said the Health Policy Commission has named administrative burden a root cause of the primary-care crisis in Massachusetts.

Karen Granoff, senior director of managed care policy at the…