Bill > H1383

This bill requires the Health Policy Commission (HPC), in collaboration with the Center for Health Information and Analysis and the Division of Insurance, to conduct a comprehensive analysis of prior authorization practices in healthcare services. Prior authorization is a process where health insurers require healthcare providers to obtain approval before delivering certain medical services or treatments. The bill mandates a detailed report examining various aspects of prior authorization, including: the types of admissions, services, and medications requiring prior authorization; approval and denial rates; review timelines; health care expenditures associated with the process; impact on patient access and cost across different demographics and regions; identification of services with low variation or denial rates; effects on chronic disease management; potential for standardized electronic authorization processes; and review of "gold-carding" (a status that may exempt certain providers from prior authorization requirements). The report must include specific data from insurance carriers about authorization requests, including approval/denial rates, processing times, and appeal outcomes. The HPC must submit the report and any legislative recommendations to the joint committee on health care financing and the house and senate committees on ways and means within one year of the act's effective date, with the goal of simplifying prior authorization processes and reducing administrative burdens on healthcare providers.

Health and Social Services

https://malegislature.gov/Bills/194/H1383