Bill > H1320

This bill aims to reduce administrative burdens in the healthcare preauthorization process by establishing a performance-based exemption system for physicians and healthcare providers. Under the proposed legislation, a health insurance carrier must waive preauthorization requirements for a specific health care service if the provider has a 90% or higher approval rate for preauthorization requests during a six-month evaluation period. The carrier must automatically evaluate providers' eligibility for this exemption every six months, though they may also choose to continue an existing exemption without a new evaluation. Importantly, providers do not need to actively request the exemption; instead, the carrier must notify them within 48 hours of determining their qualification. Once granted, the exemption remains valid for six months, unless the carrier rescinds it through a process that allows for appeal. The bill provides a mechanism for providers to challenge a carrier's decision to rescind their preauthorization exemption, with specific timelines for notification and appeal. The provisions of this bill are set to take effect on July 1, 2026, giving healthcare systems and insurance carriers time to prepare for the new requirements.

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https://malegislature.gov/Bills/194/H1320