Eliminates prior authorizations for essential care; announces Health Care Affordability Working Group to Further Lower Costs
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| Continue reading the details in the full press release |
“Health care is too difficult and too expensive for far too many people,” said Governor Healey. “So we are taking the most comprehensive action in the country to make it faster, cheaper and easier to get the care you need. This is a moment of urgency, and today we are bringing together leaders from across health care, business and labor to find every possible step we can take to lower costs and improve health care in Massachusetts.”
“This initiative is cutting unnecessary red tape that has delayed care for too many patients and drives up costs for our families and businesses,” said Lieutenant Governor Kim Driscoll. “If we are serious about lowering costs, we have to take on the waste and unnecessary barriers that are driving up the cost of health care.”
Prior authorization requires doctors to get approval from a patient's health insurance plan before providing a service or medication, which often causes long delays and increases administrative costs, which can be passed down to patients. DOI’s updated regulations streamline and standardize prior authorization practices across the health care system, reducing red tape and unnecessary barriers to care. The changes will eliminate prior authorization requirements for a wide range of services, such as emergency and urgent care services, primary care, chronic care, occupational and physical therapy and certain prescription drugs. The regulations also eliminate duplicative claims submissions and simplify approval processes, reducing administrative costs and burdens on doctors, hospitals and insurers and helping the system operate more efficiently while keeping the focus on delivering care.
For patients, these reforms mean faster, more reliable access to care and fewer delays caused by insurance paperwork. By eliminating prior authorization for many routine and essential services, requiring insurers to respond to urgent requests within 24 hours, and ensuring continuity of care when patients switch plans, the regulations reduce disruptions that can delay treatment or send patients unnecessarily to emergency rooms. Greater transparency and fewer administrative errors will also ease the burden on providers, allowing more time to focus on patient care, helping ensure people receive timely treatment when they need it most.
Some examples of how these updated regulations will impact patients include:
- A patient with diabetes will no longer need a prior authorization for any services, devices and drugs associated with their chronic disease.
- A patient with rheumatoid arthritis who has an existing authorization for his treatment but recently switched to a new insurer will have that prior authorization honored for at least 3 months.
- An insurer will be required to respond to a prior authorization request from a multiple sclerosis patient experiencing a relapse and needing steroid injections to prevent permanent nerve damage within 24 hours.
- A provider who recently diagnosed their patient with a new condition will more easily be able to identify if a prior authorization is required for a particular course of treatment.
