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Massachusetts limits prior authorization for routine care, requires 24-hour urgent decisions and creates affordability working group
Summary
Governor Healy announced new state regulations to remove prior authorization for many routinely approved treatments, require 24-hour responses for urgent requests, and establish a health care affordability working group co-chaired by Kate Walsh and Lisa Murray; regulations will be filed this week and the group aims to offer recommendations by June.
Governor Healy on Thursday announced statewide changes meant to speed patients’ access to treatment by eliminating prior-authorization requirements for a broad set of drugs, services and equipment and by requiring insurers to respond to urgent requests within 24 hours.
The governor said the rules will remove prior authorization for categories that include primary and emergency care, chronic disease management, vaccines, reproductive and maternity care, physical therapy and substance use services. "We're cutting the red tape that stands between you and health care," Healy said, adding that the goal is to prevent routine approvals—often granted "99% of the time"—from imposing months-long delays on patients.
Insurance Commissioner Mike Caljo said all insurers doing business in Massachusetts will be subject to the…
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