The bill amends Chapters 27-18 and 27-19 of the General Laws to introduce new restrictions on prior authorization requirements for rehabilitative and habilitative services in health insurance plans. It prohibits prior authorization for the first twelve visits of each new episode of care, which is defined as treatment for a new or recurring condition not previously treated by the provider within the last ninety days. Additionally, for patients diagnosed with chronic pain, prior authorization is not required for the first ninety days following diagnosis. After the initial visits, prior authorization cannot be required more frequently than every six visits or every thirty days, whichever is longer.

Moreover, the bill mandates that health insurance plans respond to prior authorization requests within twenty-four hours and outlines the process for notifying patients and providers if additional information is needed. If a plan fails to respond in a timely manner or indicates that prior authorization is not required, the request is automatically deemed approved. The bill also includes provisions for retroactive authorization for medically necessary services and ensures that denials of prior authorization are subject to the same appeal rights as other denials under existing health insurance regulations. These changes aim to streamline access to necessary services while ensuring timely responses from insurance providers, with the provisions set to take effect on January 1, 2026.