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H 4616

An Act improving the health insurance prior authorization process

194th Legislature (2025-2026) Introduced by James Arena-DeRosa and 25 co-sponsors

H 4616 - An Act improving the health insurance prior authorization process OverviewBill Number: H 4616 Title: An Act improving the health insurance prior authorization processStat

Reporting date extended to Friday, July 31, 2026
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Bill Summary · H 4616

H 4616 - An Act improving the health insurance prior authorization process

Overview

Bill Number: H 4616
Title: An Act improving the health insurance prior authorization process
Status: Reported favorably by committee and referred to the committee on Health Care Financing
Introduced: October 20, 2025

Purpose and Intent

This bill aims to streamline and standardize the prior authorization process for health insurance coverage in the state. Prior authorization is the requirement that healthcare providers obtain approval from insurers before certain medical services, procedures, or medications can be provided to patients. The goal is to reduce administrative burdens, improve transparency, and ensure timely access to necessary care.

Key Provisions

  • Requires health insurers to establish an electronic prior authorization process that can receive and respond to requests electronically
  • Mandates that insurers make prior authorization criteria, requirements, and restrictions publicly available on their websites
  • Prohibits insurers from requiring prior authorization for emergency services or for certain common services like annual wellness visits
  • Sets strict timelines for insurers to respond to prior authorization requests, with 72 hours for urgent care and 15 calendar days for non-urgent
  • Allows healthcare providers to appeal prior authorization denials through an independent review process

Affected Parties and Impacts

This bill would impact all health insurance plan members in the state by improving their access to timely, necessary medical care. Healthcare providers would benefit from reduced administrative burdens and more transparency around prior authorization requirements. Insurers would need to update their systems and processes to comply with the new electronic and timeline requirements.

Procedural and Timeline Considerations

H 4616 has been reported favorably by the committee with jurisdiction over insurance matters and has been referred to the committee on Health Care Financing for further consideration. If passed by the legislature and signed into law, the new prior authorization requirements would take effect 6 months after the bill's enactment.

Compiled from official sources — confirm details with the bill’s official record.

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