The bill amends the General Laws to impose restrictions on prior authorization requirements for rehabilitative and habilitative services in health insurance plans. It specifically prohibits prior authorization for the first twelve visits of a new episode of care, defined as treatment for a new or recurring condition for which an insured has not been treated by the provider within the previous ninety days. After these initial visits, prior authorization cannot be required more frequently than every six visits or every thirty days, whichever time period is longer. For patients diagnosed with chronic pain, the bill states that prior authorization cannot be required for the first ninety days following the diagnosis, with the same frequency limitations applying thereafter.

Additionally, the bill mandates that health insurance plans respond to prior authorization requests within twenty-four hours. If more information is required to render a decision, the plan must notify the patient and provider within twenty-four hours of the initial request. A prior authorization request is deemed approved if the plan fails to respond in a timely manner or informs the provider that prior authorization is not required. The legislation also requires health insurance plans to provide a procedure for obtaining retroactive authorization for medically necessary services that are covered benefits. Denials of prior authorization are subject to the same appeal rights as other denials under health insurance regulations. These provisions are set to take effect on January 1, 2027.