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HD 3505

An Act relative the use and impact of prior authorization for health care services

194th Legislature (2025-2026) Introduced by John Lawn

Summary of HD 3505: An Act Relative to Prior Authorization for Health Care Services Purpose and IntentThis proposed bill aims to address concerns around the use of prior authorizat

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Bill Summary · HD 3505

Summary of HD 3505: An Act Relative to Prior Authorization for Health Care Services

Purpose and Intent

This proposed bill aims to address concerns around the use of prior authorization requirements by health insurance providers for various health care services. Prior authorization is the process where insurers require providers to obtain approval before delivering certain treatments or services in order for those services to be covered. The bill seeks to increase transparency and efficiency in this process in order to improve patient access to necessary care.

Key Provisions

  • Requires health insurance carriers to publicly disclose all services and procedures that require prior authorization, as well as the criteria used to make those determinations.
  • Mandates that prior authorization decisions be made within 2 business days for standard requests and 1 business day for expedited/urgent requests.
  • Prohibits insurers from retroactively denying coverage for services that received prior authorization approval.
  • Establishes an independent review process for providers to appeal prior authorization denials.
  • Imposes financial penalties on insurers that fail to comply with the new prior authorization requirements.

Affected Stakeholders

  • Health insurance carriers that currently require prior authorization for certain health services
  • Health care providers, including doctors, hospitals, and other medical facilities, who must navigate the prior authorization process
  • Patients seeking coverage for various treatments and procedures that may be subject to prior authorization

Timeline and Next Steps

The bill was introduced in the state legislature on November 29, 2025 and has been referred to the Joint Committee on Health Care Financing for consideration. If passed by both chambers of the legislature, the new prior authorization requirements would take effect starting January 1, 2027 to allow time for insurers to update their policies and procedures.

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

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