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

The bill also outlines the responsibilities of health insurance plans regarding prior authorization requests, mandating a response within twenty-four hours and requiring notification to patients and providers if additional information is needed. If a plan fails to respond timely or indicates that prior authorization is not required, the request is automatically deemed approved. Furthermore, the bill allows for retroactive authorization for medically necessary services provided without prior authorization, as long as medical necessity can be established post-service. It ensures that denial of coverage cannot occur solely due to failure to obtain prior authorization, thereby streamlining access to necessary services while enhancing communication and decision-making from health insurance providers. The act is set to take effect on January 1, 2026.