Massachusetts Gov. Maura Healey is the latest state leader to push for prior authorization reform, fleshing out her plan in a Jan. 14 news release.
Just one day prior, New York Gov. Kathy Hochul had shared her intentions to tackle pressing healthcare issues in the state, including prior authorization. Meanwhile, a slew of state laws kicked off at the top of the year to speed up prior authorization decisions.
“We are taking the most comprehensive action in the country to make it faster, cheaper and easier to get the care you need,” Ms. Healey said. “This is a moment of urgency, and today we are bringing together leaders from across healthcare, business and labor to find every possible step we can take to lower costs and improve healthcare in Massachusetts.”
Ms. Healey shared these five regulatory updates:
1. Insurers would have 24 hours to reply to urgent prior authorization requests.
2. Diabetes patients are among those who would no longer need prior authorization for any services, medications or devices.
3. Prior authorizations would be honored for longer under continuity of care policies. For example, a rheumatoid arthritis patient with an existing prior authorization would be able to retain it for at least three months if they switch insurers.
4. Much like Ms. Hochul’s efforts, Ms. Healey is also pushing for greater transparency with prior authorization, so providers “will more easily be able to identify if a prior authorization is required for a particular course of treatment,” the release said.
5. Ms. Healey is launching the Health Care Affordability Working Group, run in part by the state’s former Health and Human Services Secretary Kate Walsh. The group will target administrative waste, pricing and inefficiencies. Payer leaders will participate, including Blue Cross Blue Shield of Massachusetts President and CEO Sarah Iselin and Massachusetts Association of Health Plans President and CEO Lora Pellegrini.
“We look forward to working with the division through the regulatory process to ensure that reforms are implemented thoughtfully, preserve appropriate clinical safeguards and build on the progress already underway to simplify prior authorization across the system,” Ms. Pellegrini said.
