Bill > S1403

This bill aims to reduce administrative burden in healthcare by implementing several key provisions related to prior authorization processes. It requires health insurance carriers to publicly list all items, services, and medications that require prior authorization on their websites, and to report annually to the Division of Insurance detailed data about prior authorization requests, including approval and denial rates. The bill mandates that carriers develop utilization review criteria that are scientifically derived and evidence-based, with input from participating physicians. It introduces new protections for patients, such as preventing carriers from retrospectively denying already approved authorizations and ensuring that patients stable on a treatment can continue that treatment for at least 90 days after changing insurance. The bill also introduces regulations for the use of artificial intelligence in utilization review, requiring that AI tools do not discriminate, can be audited, and cannot be the sole basis for denying healthcare services. Additionally, the bill establishes a task force to study the impact of prior authorization on healthcare costs and access, with the goal of developing recommendations to simplify and standardize prior authorization processes across carriers. Most provisions of the bill will take effect on January 1, 2026, with some specific sections having different implementation dates.

Budget and Finance, Health and Social Services

https://malegislature.gov/Bills/194/S1403