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H 1118

An Act relative to prior authorization requests

194th Legislature (2025-2026) Introduced by Mark Cusack

Massachusetts health plans must staff 24/7 to review and respond to prior authorization requests within 24 hours, including evenings, weekends, and holidays.

Accompanied a study order, see H5066
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Bill Summary · H 1118

Summary: H.1118 An Act relative to prior authorization requests

Overview

H.1118, introduced February 27, 2025 by Representative Mark J. Cusack, seeks to require health insurance plans to maintain adequate staffing to review and respond to prior authorization requests within 24 hours, including during evenings, weekends, and holidays. The bill is currently scheduled for a hearing on July 15, 2025, in the House from 10:00 AM to 1:00 PM (Committee A-2). The measure is related to the prior authorization process for services or benefits deemed medically necessary by a patient’s treating provider.

Purpose and intent

  • To reduce delays in obtaining approval for medically necessary services by ensuring timely review of prior authorization requests (PA requests).
  • To address access to care concerns arising from extended or non-business-hour processing times by mandating around-the-clock staffing for PA review.

Key provisions

  • Definitions:

    • “Health care plans” means plans defined by Section 1 of Chapter 6D of the Massachusetts General Laws.
    • “Prior authorization request” means a submission by a health care provider to a patient’s health insurance plan for approval of a service or benefit deemed medically necessary by the treating provider.

  • Staffing and turnaround requirements:

    • All health insurance plans governed by the statute must ensure adequate staff during evenings, weekends, and holidays.
    • Such staffing must review and respond to any PA request within 24 hours of receipt.

Affected parties

  • Health insurance plans operating in Massachusetts (as defined by Chapter 6D).
  • Health care providers who submit PA requests on behalf of patients.
  • Patients insured under these plans who rely on timely approvals for services or treatments.

Procedural and timeline aspects

  • Introduced: February 27, 2025.
  • Referred to the Senate and House committee on Financial Services (Massachusetts General Court context).
  • Hearing: Scheduled for July 15, 2025, from 10:00 AM–1:00 PM in Room A-2.
  • Related actions: House Bill 3149 (HD 3149) is listed as related/replacing in the docket context.

Potential impacts and considerations

  • Positive impacts:

    • Shorter wait times for PA decisions, potentially accelerating access to needed care.
    • Consistency in PA processing across all hours, reducing disparities for off-hours requests.

  • Potential costs and challenges:

    • Increased administrative and staffing costs for insurers to cover evenings, weekends, and holidays.
    • Operational implications for plan administrators to staff and manage 24/7 PA workflows.
    • No explicit exceptions or phased implementation details are provided in the bill text.

Notes

  • The bill explicitly overrides other laws “notwithstanding any general or special law to the contrary” for its staffing and turnaround requirements.
  • The exact effective date and any implementation timeline beyond the 24-hour standard are not specified in the text provided.

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

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