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Bill

S 796

Relates to information regarding the home energy assistance program for participants in the elderly pharmaceutical insurance coverage program

2025 Regular Session Introduced by Cordell Cleare

Insurers must reply to completed prior authorization requests within 24 hours and may not delay decisions through appeals or administrative tactics; audits will enforce.

SUBSTITUTED BY A1099
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Bill Summary · S 796

Summary — S.796 (2025): An Act relative to reducing unnecessary delays in patient care

Main purpose

The bill amends Massachusetts General Laws (chapter 176O, section 25(b)) to accelerate insurer responses to completed prior authorization requests and to prohibit payers from using administrative processes to delay care. Its stated goal is to reduce unnecessary delays in patient care caused by prior authorization and related insurer practices.

Key provisions

  • Changes the required insurer response time for completed prior authorization requests from “2 business days” to “24 hours.”
  • Adds a prohibition: payers and entities acting for payers under contract shall not use appeals processes or other administrative means to delay responding to a completed prior authorization request from a provider.
  • Directs “the division” to conduct audits to ensure compliance with this subsection (i.e., to verify payers meet the 24-hour response requirement and do not employ delaying tactics).

Who is affected

  • Patients: Expected to receive faster decisions on prior authorization requests, potentially shortening wait times for medically necessary services and treatments.
  • Providers (physicians, hospitals, clinics): Will benefit from quicker determinations on completed prior authorization submissions; may need to ensure requests are “complete” per payer requirements.
  • Payers (insurers, managed care organizations and their contractors): Must respond within 24 hours and cannot use appeals or administrative maneuvers to delay responses; may face operational and compliance changes and potential audit scrutiny.
  • The referenced “division” (the bill text does not spell out which agency) will carry out audits — typically this would be the state Division of Insurance or another oversight entity responsible under chapter 176O.

Enforcement and compliance

  • The bill authorizes audits by the division to monitor and enforce compliance with the 24-hour response requirement and the ban on delay tactics.

Legislative status and timeline (as provided)

  • Introduced/Filed: S.796 filed 1/16/2025; listed as introduced in the Senate on 2/27/2025. Presented by Sen. Mark C. Montigny (petition also names Rep. Christopher M. Markey).
  • Referred to Committee on Financial Services / Committee on Finance; hearings scheduled (listed July 15, 2025).
  • Status note: the bill record indicates it was “SUBSTITUTED BY A1099” (listed 2025-02-05), and A1099 is cited as the companion — meaning S.796 was later replaced by a House bill (A1099) for further action. (Some dates in the provided record appear inconsistent; the substitution date precedes some filing dates.)

Potential impact and considerations

  • Positive: Faster authorizations could reduce treatment delays and emergency care needs, improving patient outcomes and provider workflow.
  • Implementation: Insurers will need procedures/staffing to meet a 24-hour turnaround on completed requests; definitions of a “completed” request and scope of permissible follow-up will be important.
  • Oversight: Effective audits will depend on clear authority and resources for the enforcing division.
  • Drafting notes: The bill text refers generically to “the division” and to “payers and entities acting for payers,” so follow-up language in the substituted/companion bill may clarify enforcement, definitions, and penalties.

If you want, I can:
- Compare S.796 to the substituted companion A1099 and summarize any differences; or
- Draft a one-page explainer for providers on how the proposed 24-hour rule would change prior authorization workflows.

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

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