Lawmakers heard extended testimony Tuesday on H.1136, an act to improve the health-insurance prior-authorization process, with physicians, hospitals and consumer advocates asking for time limits, clearer lists of services that require authorization and rules to preserve treatment when patients change plans.

The bill would require faster insurer responses for urgent requests, standardize which services are subject to prior authorization, make prior authorizations valid for the length of treatment or at least one year, and create a transition period when patients switch plans so care is not interrupted.

Supporters said the current system delays care, creates administrative waste and contributes to clinician burnout. "Prior authorization unnecessarily delays and denies access to medically necessary care for patients, and it causes costly administrative waste," said Lita Anderson, director of advocacy and government relations for the Massachusetts Medical Society. Anderson told the committee prior authorization is the No. 1 issue members raise and said the Health Policy Commission has named administrative burden a root cause of the primary-care crisis in Massachusetts.

Karen Granoff, senior director of managed care policy at the Massachusetts Health and Hospital Association, told lawmakers that hospitals operating 24/7 often cannot obtain timely responses from plans to arrange post-acute transfers, worsening capacity problems. "Insurance issues were the number one problem in timely discharges," Granoff said, and she noted federal CMS rules on prior authorization will require public reporting beginning in 2026.

Patient advocates and clinicians described cases in which authorization delays or repeated reauthorizations led to hospitalizations. Veronica Rosnick, a primary-care physician at Brigham and Women's Faulkner Hospital and chair of the Massachusetts Chapter of the American College of Physicians, described a patient who waited a week for an authorization for insulin and was later hospitalized with a severe infection. "If H.1136 had been in place, we could have reduced cost by keeping both of these patients out of hospital and overall improve their medical outcomes," Rosnick said.

Cancer specialists from Dana-Farber reported low clinical denial rates but lengthy authorization workflows and third-party review vendors that add steps and delay treatment for complex patients. Stacy Rosenblum, Dana-Farber's senior director for referrals and clinical authorizations, described an instance in which an FDA-approved immunotherapy was denied and staff had to pursue a time-consuming appeals and peer-review process while the patient continued treatment.

Health Care for All senior policy director Ashley Blackburn described examples collected on a consumer helpline: one cardiology referral marked urgent that took nearly a month of back-and-forth before approval; other callers reported medication lapses after changing plans and repeating prior authorization steps. Wells Wilkinson of Health Law Advocates said the bill's requirement that plans publish a clear list of services subject to prior authorization and build a digital interface for providers could help consumers avoid unexpected bills.

Witnesses cited national studies and state-level estimates of administrative waste: the Massachusetts Health and Hospital Association has estimated that sensible administrative reforms could remove roughly $1.75 billion in wasted costs from the state's health-care system, and clinicians cited an American Medical Association study that found an average of 39 prior authorizations per provider per week and about 13 provider-hours weekly spent processing them. Speakers emphasized that H.1136 does not eliminate prior authorization but aims to make it data-driven and more transparent.

Committee members questioned whether insurers use automation or artificial intelligence in authorization decisions and whether peer-to-peer reviews are being executed as intended. Several clinicians said peer-to-peer calls are logistically difficult and often scheduled or routed in ways that prevent timely physician responses; they urged rules allowing scheduled peer reviews with appropriately trained reviewers. "Calls from reviewers come to different places in the organization," said Alexa Kimball, CEO of Harvard Medical Faculty Physicians. "Physicians are seeing patients or doing other things and cannot always break out to answer that call."

Testimony listed potential consumer protections in the bill: mandated lists of services requiring prior authorization; a one-year minimum validity for prior authorizations or coverage for the duration of treatment; a short response timeframe for urgent requests; and standardization and data reporting that mirror anticipated federal requirements.

The hearing produced no committee votes; witnesses asked the committee to report the bill favorably. The committee closed the hearing at the end of the session.