MA H1136

Requires health insurance carriers to publish searchable lists of all items, services, and medications requiring prior authorization on their websites, with annual reporting to the Division of Insurance on approval/denial rates by July 1 each year

Prohibits retrospective denial of previously approved authorizations unless based on fraud, limits claim recoupment to 1 year, and automatically grants prior authorization requests not responded to within required timeframes or for items not publicly listed as requiring authorization

Mandates coverage continuity for patients stable on treatments: at least 90 days when switching plans, and through the benefit year (or 90 days minimum) if a drug/service is removed from formulary mid-year; preauthorization approvals valid for duration of treatment or at least 1 year

Requires carriers to implement electronic prior authorization APIs conforming to federal HIPAA and HL7 FHIR standards, and prohibits use of artificial intelligence as the sole basis for denying care—denials must be made by licensed physicians with relevant clinical expertise

Establishes a 15-member task force to study prior authorization impacts on costs and care access, with report due July 31, 2026; Division of Insurance to implement uniform rules by April 1, 2027, including prohibiting prior authorization for services with low denial rates or established evidence-based chronic disease treatments