Healey unveils health insurance reforms

BOSTON — Massachusetts health insurers will be required to streamline, and in some cases scrap altogether, pre-approval for many routine medical procedures and medications under proposed new state rules unveiled by Gov. Maura Healey.

Healey announced Wednesday that she has directed the state Division of Insurance to update its regulations to streamline prior authorization for a wide range of medical procedures, including emergency and urgent care services, primary care, occupational and physical therapy and some prescription drugs.

Healey said the changes will reduce unnecessary delays and cut administrative burdens "to make it easier, cheaper and faster for people to get the medications and care they need."

"We're cutting the red tape that stands between you and health care," Healey said in remarks at the Statehouse Wednesday, flanked by state officials, lawmakers and business leaders. "From now on, a wide range of medical drugs, services, and equipment will no longer need any prior authorization at all."

Healey also announced Wednesday that her administration will be convening a 30-member "Health Care Affordability Working Group" that will be tasked with coming up with new recommendations to reduce health care costs and improve access to care.

The health care industry spent $1.3 billion on administrative costs related to prior authorizations in 2023, according to a report from the Council for Affordable Quality Healthcare. That's a 30% increase over the previous year, the group said.

Lora Pellegrini, president & CEO of the Massachusetts Association of Health Plans, praised Healey for convening the task force but highlighted potential pushback over the proposal to scrap pre-authorization for medical procedures.

"Prior authorization plays an important role in ensuring patients receive the right care, at the right time, and in the right setting, and plans have been actively working to streamline and modernize these processes, with the goal of advancing electronic prior authorization and automation to make the process more efficient for providers and patients alike," she said in a statement.

"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," she added.

The changes are the latest effort by Beacon Hill to blunt the impact of skyrocketing health care premiums that officials say are forcing people to make difficult budget decisions in order to afford medical treatment.

Last week, Healey announced that her administration is pumping an additional $250 million into the state-subsidized health system to help offset the impact of now-expired federal tax credits, which have driven up premiums for many health care consumers.

Healey called it the "largest state investment in the country" and said it means about 270,000 people enrolled in ConnectorCare, whose incomes are below 400% of the federal poverty level, will "see little to no premium increases" because of the expiring federal credits.

Insurance Commissioner Michael Caljouw said the new requirements rolled out Wednesday "will reduce and simplify these processes, increasing overall transparency and improving the timeliness of patient care."

"Prior authorization requirements have grown in complexity over time, confusing patients and doctors and delaying important care," he said. "Similarly, insurers and patients are too often forced to deal with duplicative bills that create additional complexity and cost for the health care system."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites. Email him at [email protected].