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SD 880

An Act streamlining the prior authorization process

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

Real-time automated prior authorization for services clearly meeting medical necessity, published on a list; carriers must implement by 2028 (list by 2027) to speed care.

House concurred
0
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Bill Summary · SD 880

Summary: An Act streamlining the prior authorization process (SD 880)

Overview

SD 880, titled “An Act streamlining the prior authorization process,” seeks to modernize and accelerate the approval of certain covered healthcare services in Massachusetts by creating a pathway for real-time automated prior authorizations. The bill is a proposed measure filed in January 2025 by Senator John J. Cronin (Senate Docket No. 880; Senate No. 706) and referred to the Joint Committee on Financial Services. The House has concurred on the measure.

Key dates:
- Filed: January 15, 2025
- Referred to committee: February 27, 2025
- House concurrence: February 27, 2025
- Publication deadline for list: January 1, 2027
- Full automation deadline for carriers: January 1, 2028

What the bill would do (Key Provisions)

  • Real-time automated approvals list

    • The Commissioner of Insurance must develop a list of health care services that are appropriate for real-time automated approval of prior authorization requests when electronic clinical information clearly demonstrates medical necessity.
    • The focus is on services with high prior authorization approval rates and clearly established clinical treatment protocols.

  • Stakeholder input

    • In developing the list, the Commissioner must seek input from the Massachusetts Collaborative and other interested stakeholders.

  • Public posting

    • The Division of Insurance must publish the list on its website no later than January 1, 2027.

  • Automation requirement for carriers

    • Carriers that require prior authorization for services on the published list must implement an automated, real-time approval process for services that clearly meet medical necessity criteria no later than January 1, 2028.

  • Supersession language

    • The bill states that, notwithstanding any other law to the contrary, these provisions will govern the specified real-time prior authorizations.

Who would be affected

  • State agencies

    • Commissioner of Insurance and the Division of Insurance (DOI) within Massachusetts.

  • Healthcare payers

    • Health insurers and other carriers operating in Massachusetts that require prior authorization for covered services listed by the DOI.

  • Providers and patients

    • Healthcare providers submitting electronic prior authorization requests (e.g., clinicians and IT systems) and patients whose services fall within the newly defined list.

  • Stakeholders

    • The Massachusetts Collaborative and other stakeholders involved in hospital/healthcare policy and administration.

Timeline and procedural notes

  • Publication timeline

    • List of eligible services must be published by January 1, 2027.

  • Implementation timeline

    • Carriers must implement automated real-time approvals for listed services by January 1, 2028.

  • Legislative path

    • Filed in the Senate as SD 880 (Senate No. 706), introduced by Sen. Cronin; referred to Financial Services.
    • House concurrence indicates alignment with House leadership on the measure during the 2025-2026 session.

Potential impact and considerations

  • Administrative efficiency

    • Aimed at reducing delays and administrative burden by enabling real-time decisions when medical necessity criteria are clearly met.

  • Access and consistency

    • Could improve timely access to care for services on the list and promote consistent decision-making across carriers.

  • Implementation challenges

    • Requires robust electronic submission standards and clear medical necessity criteria.
    • Requires significant IT upgrades for carriers and clear protocols for real-time determinations.

  • Oversight and transparency

    • The published list and stakeholder input provide oversight and transparency to the prior-authorization process.

This bill would enact a structured, phased approach to automating prior authorization for select services, with specific publication and implementation deadlines aimed at expediting care where clinically appropriate.

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

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